Pathology/Lab Coding Alert

2-character modifier just might get you paid You may not be using them yet, but CPT's new genetic test modifiers can help your lab show medical necessity for genetic studies, which can ease reimbursement.

Because CPT Codes describe only the lab process, coding couldn't indicate what genetic mutation you were testing for - until now. And because insurers didn't know what you were testing for, they were sometimes reluctant to pay.

Genetic-test coding will continue to specify the lab procedure using the same CPT codes you've always used. But now, with nearly 85 modifiers added in CPT 2005, you can also provide more information about the genetic condition and the test's purpose. Using the modifiers, however, won't affect the amount of a procedure's payment. Learn the Numeric-Alpha Distinction The new genetic testing code modifiers are two-character numeric/alpha codes. "An appendix in CPT 2005 organizes new modifiers for specific genetic tests based on specific disease categories," says Laurie Castillo, CPC, CPC-H, CCS-P, owner of Castillo Consulting in Manassas, Va. Different versions of the CPT manual list the modifiers in different appendixes. The following groupings make up the numeric component of each two-digit modifier:

 0 and 1 - Neoplasia (solid tumor)
 2 - Neoplasia (lymphoid/hematopoetic)
 3 - Non-neoplastic hematology/coagulation
 4 - Histocompatibility/blood typing
 5 - Neurologic/non-neoplastic
 6 - Muscular, non-neoplastic
 7 - Metabolic, other
 8 - Metabolic, transport
 9 - Metabolic-pharmacogenetics; Dysmorphology   For each category, CPT lists numeric/alpha modifiers specific for established gene mutations. The numeric digit indicates the disease category, and the alpha character specifies gene type. CPT reserves the letter "Z" for not-otherwise-specified (NOS) genetic mutation within each disease-type category.

Using the modifiers allows you to provide specific information about a genetic test your lab performs without changing the way you use CPT procedure codes. "With the explosion in genetic testing, creating the two-digit modifier system provides the potential to describe 260 specific genetic mutations without adding new CPT codes for each," says Diana Voorhees, MA, CLS, MT(ASCP)SH, CLCP, principal with DV & Associates Inc. in Salt Lake City.

Modifiers for some common tests include 0A for BRCA1 (hereditary breast/ovarian cancer), 0I for Her-2/neu, 3A for Factor V (Leiden, others; Hypercoagulable state), and 8A for CFTR (Cystic fibrosis mutations). See the Clip-and-Save Chart in an upcoming article for a complete list of the modifiers. Use Modifiers With Codes for Specific Genes CPT directs you to use these modifiers "with molecular laboratory procedures related to genetic testing." You'll find introductory guidelines for using the new modifiers at the start of the cytogenetic studies section for [...]