Pathology/Lab Coding Alert

Unlisted Services:

Avoid Least-Specific Code Choice With These Tips

Published on Fri Oct 08, 2021

Check all code categories and method codes.

If you don’t know the code for a procedure your pathology or clinical lab report describes, don’t automatically turn to an unlisted code. Instead, take the following steps to find the correct code.

If you can’t find an exact 80000-level code match, let our experts help you drill down to the right way to bill for the service so you can collect the pay you deserve.

Look Beyond Category I

After you check the CPT^® manual index or use an online coding tool such as Codify (www.aapc.com/codes/all_coding_tools/home), you can do some more sleuthing to find a code.

If you know the type of test (such as chemistry), you can turn to that section in the CPT^® manual and look for an appropriate code based on the section organization — such as alphabetical by analyte for the chemistry section. If you don’t find the code in that section, remember that Category I is not the only option.

If you know the type of test (such as chemistry), you can turn to that section in the CPT^®manual and look for an appropriate code based on the section organization — such as alphabetical by analyte for the chemistry section. If you don’t find the code in that section, remember that Category I is not the only option.

Turn to Appendix O: If the test is a Multianalyte Assay with Algorithmic Analyses (MAAA) or Proprietary Laboratory Analysis (PLA), you’ll find the code listed in Appendix O. But Category I codes are just the beginning of this appendix. You’ll find all the PLA tests in this appendix — they’re codes with four numerals followed by “U.” Each PLA code describes a specific test performed by a single lab or provided by a single manufacturer. If your lab performs a specific proprietary test, you must use the PLA code — it takes priority over 80000-level codes.

Don’t miss: Appendix O also includes some administrative codes, which are four numerals followed by “M.” These also take priority over unlisted codes.

Check Category III: CPT^®lists “temporary” codes with four numerals followed by “T” in the Category III section. The purpose of these codes is to allow data collection regarding how often clinicians perform a particular service. That means you should not use an unlisted Category I code if CPT^®provides a Category III code for a procedure — the later takes priority, according to the section guidelines.

Caution: Category III codes have an expiration date, typically after five years. Before expiration, CPT^®either converts the procedure to a Category I code or archives the code due to limited use. “If you’ve used a Category III code in the past, you need to ensure that it’s still valid in the current year,” says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, billing specialty subject matter expert at Kareo in Irvine, Calif. If the code is gone, you’ll either need to report the service as the replacement Category I code, or use an unlisted code.

For instance: CPT^®2022 deletes 0423T (Secretory type II phospholipase A2 (sPLA2-IIA)), which had a sunset date of Jan. 2022. With no Category I replacement code, you’ll need to report this test with the chemistry unlisted code 84999 (Unlisted chemistry procedure).

Make Sure Code is Exact

Close only counts in horseshoes, as the saying goes. “CPT^®is explicitly clear that ‘close’ is not appropriate when determining the code to report,” says Marvel Hammer, RN, BS, CPC, CCS-P, ACS-PM, CPCO, owner of MJH Consulting in Denver. You should use a listed code only if the service is an exact match to the code definition.

For example: Going back to the 0423T deletion, don’t be tempted to report the test using 83698 (Lipoprotein-associated phospholipase A2 (Lp-PLA2)), even though the definition looks similar. In fact, before deleting 0423T, CPT^®provided a text note under the code to clarify that 83698 is a different test: “For lipoprotein-associated phospholipase A2 (Lp-PLA2), use 83698.”

Lab method: Before you turn to an unlisted code, remember CPT^®provides several codes that describe the lab method, but not the analyte, such as 82542 (Column chromatography, includes mass spectrometry, if performed (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen). Choosing that code is more specific than the unlisted chemistry code, 84999.

Example: If the lab performs an infectious agent antigen detection by immunoassay for an organism that isn’t listed, you should choose the appropriate code depending on the method, such as 87449 (Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; not otherwise specified, each organism) or 87899 (Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; not otherwise specified). Although the infectious agent antigen detection codes are in the microbiology section, you should not report 87999 (Unlisted microbiology procedure).

Key: “If a lab-method code is available that describes the test you’re performing, you should select the method code instead of using a less-specific ‘unlisted’ code,” says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Know the Unlisted Codes for Labs

If you face a lab or pathology procedure that really doesn’t have a specific code in any category or a specific method code, you’ll have to choose an unlisted code. But that doesn’t mean you’re done making decisions.

CPT^®provides an unlisted code for almost every section in the Pathology and Laboratory chapter, so you need to know what type of procedure you’re coding. To help with the process, here’s a list of the unlisted pathology/laboratory codes: