Pathology/Lab Coding Alert

You can't override new cytopathology or thyroid bundles

Watch out for two new National Correct Coding Initiative (NCCI) edit pairs you can't override: "other source" cytopathology tests 88160 and 88161, and T3 thyroid tests 84480 and 84481.
 
Because NCCI version 11.1 lists these code pairs with a "0" modifier indicator, you can't override the bundled tests - even for different specimen sources. Version 11.1 went into effect April 1, and you can access the edits at www.cms.hhs.gov/physicians/cciedits/default.asp.

Know When You Can't Unbundle

You can't get paid for both services if your lab performs a cytopathology smear from a non-gynecology,   -fluid, -washing or -brushing source (88160, Cytopathology, smears, any other source; screening and interpretation) and a touch prep from a separate specimen (88161, ... preparation, screening and interpretation). Labs perform touch preps by crushing a slide against a tissue specimen, allowing cells to adhere to the slide for staining and evaluation.
 
Bottom line: "Because NCCI lists the 88160, 88161 edit pair with a 0 modifier indicator, you can't override the edit pair under any circumstances," says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.
 
The good news is that labs don't perform many "other source" cytopathology screening exams. "We really don't use 88160 very much, so having a conflict with the 88161 NCCI edit would be rare," says R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark. "Sputum and nipple secretions are among the few cytopathology samples that fall into this category of non-gynecological, and non-fluids, -washings or            -brushings specimens," he says.
 
And since labs typically concentrate sputum specimens by various methods, you would list that exam as 88108 (Cytopathology, concentration technique, smears and interpretation [e.g., Saccomanno technique]) or 88112 (Cytopathology, selective cellular enhancement technique with interpretation [e.g., liquid-based slide preparation method], except cervical or vaginal) instead of 88160.
 
But if your lab does process a smear from nipple discharge (88160) and a touch prep from a breast biopsy (88161) for the same patient, NCCI will prohibit payment for both services even though they represent separate specimens. "NCCI also bundles 88161 with other cytopathology codes (88104-88108), but a modifier indicator of 1 allows you to override the edit pair with modifier -59 (Distinct procedural service) if the lab examines separate specimens," Dettwyler says.

11.1 Creates T3 Edit

Don't miss: NCCI 11.1 adds another edit pair you can't override: 84480 (Triiodothyronine T3; total [TT-3]) and 84481 (... free). "The 0 modifier indicator with this code pair should not present a big problem because physicians would not be likely to order both free and total T3 tests, since they provide similar diagnostic information," Dettwyler says. "However, the physician may order both tests in cases of nutritional dysfunctions where the total and free T3 may differ significantly."
 
Similarly, NCCI already lists with a 0 modifier indicator other thyroid tests that provide redundant diagnostic information: 84439 (Thyroxine; free) with 84436 (Thyroxine; total) and 84479 (Thyroid hormone [T3 or T4] uptake or thyroid hormone binding ration [THBR]). "Labs need to educate physician clients about these thyroid-test edit pairs to avoid lost payment for uncovered tests," Dettwyler says.

Watch for Protein Tests by Different Methods

 When your lab performs a total protein test, you have to choose between different codes based on the lab method and specimen source.
 
NCCI 11.1 says you can't get paid for both a refractometry test (84160, Protein, total, by refractometry, any source) and a test by any other method (84155, Protein, total, except by refractometry; serum; or 84156, ... urine; or 84157, ... other source [e.g., synovial fluid, cerebro-spinal fluid]).
 
These edit pairs are mutually exclusive, which means that the lab would typically perform one or the other procedure, not both. "Labs often use refractometry for total protein when they're also performing a protein electrophoresis (84165, Protein; electrophoretic fractionation and quantitation, serum). That's when you should report 84160 instead of one of the 84155-family codes," Dettwyler says.

Override Bundles for Different Organism or Source

CPT provides a host of codes for identifying infectious agents from different sources and by different methods - and NCCI bundles many of these codes.
 
NCCI 11.1 adds new edit pairs for recent CPT codes for Trichomonas and giardia tests: