Pathology/Lab Coding Alert

Add the key fifth digit for 287.3

Expecting to get paid for HIV or other lab tests for patients with low platelet counts? Then you’d better report updated ICD-9 codes for thrombocytopenia.
 
Forget 287.3: ICD-9 invalidated 287.3 as of Oct. 1 when it introduced a series of five, more-specific five-digit codes to use in its place. Now Medicare has updated five Laboratory National Coverage Determinations (NCDs) to require the expanded codes to show medical necessity.

Follow Updated NCDs

HIV isn’t the only lab test that requires the new ICD-9 codes--but it’s the most expensive. Codes 87535 (Infectious agent detection by nucleic acid [DNA or RNA]; HIV-1, amplified probe technique) and 87538 (… HIV-2, amplified probe technique) pay $49.04 (national limit). And that’s the amount you stand to lose if the physician orders the test with 287.3 (Primary thrombocytopenia).

Be specific: Instead, you must be certain that the physician reports the condition more specifically using one of the new codes:

• 287.30--Primary thrombocytopenia, unspecified Megakaryocytic hypoplasia

• 287.31--Immune thrombocytopenic purpura Idiopathic thrombocytopenic purpura
Tidal platelet dysgenesis

• 287.32--Evans’ syndrome

• 287.33--Congenital and hereditary thrombocytopenic purpura
Congenital and hereditary thrombocytopenia Thrombocytopenia with absent radii (TAR) syndrome

Excludes: Wiskott-Aldrich syndrome (279.12)

• 287.39--Other primary thrombocytopenia.

Bottom line: Failure to use one of these five-digit codes when a physician orders a test due to thrombocytopenia could mean failure to show medical necessity--and failure to get paid. Medicare updated NCDs for the following tests

• Fecal occult blood test (82270)
• Serum iron tests (82728, 83540, 83550, 84466)
• Partial thromboplastin time (85730)
• Prothrombin time (85610)
• HIV (86689, 86701, 86702, 86703, 87390, 87391, 87534, 87535, 87537, 87538).

Truncated Codes Are No Good

ICD-9 coding rules require that you report codes to the highest degree of specificity. That means you should use specific four- or five-digit codes, when available, instead of general three-digit codes. So-called “truncated diagnoses” have never been acceptable, says Barbara J. Cobuzzi, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions in Shrewsbury, N.J

Don’t miss: CMS updated lab NCDs to comply with this ICD-9 coding principle by changing the list of payable diagnosis codes to include 287.30-287.39, but exclude 287.3.

Avoid Denials With Updated Code Sets

Now that CMS no longer allows a 90-day grace period, your lab should have updated ICD-9 code sets effective on the implementation date: Oct 1. Although you may not see the lab NCDs updated to accept these codes until that date, the ICD-9 changes were announced in the May 4 Federal Register. 

What to do: You shouldn’t encounter many coding difficulties or denials without a grace period as long as you update your code sets by the ICD-9 deadline, says Melanie Witt, RN, CPC, MA, an independent coding consultant in Guadalupita, N.M. The Federal Register usually publishes new codes well in advance of their release, so you should have enough time to make the changes, she adds.