Pathology/Lab Coding Alert
Use 86586 for Unspecified Immunology Counts
Don't report flow cytometry for clinical lab tests You'll need to learn a new way to use "unlisted antigen" code 86586 with CPT 2005's changes for immunology and flow cytometry coding. While you used to mix and match codes from immunology (86000s) with the flow cytometry code from cytopathology (88180 before 2005), that's no longer the way to go. Discover 86586 'Change' in CPT 2005 Depending on the publisher of your CPT book, you may or may not see 86586 listed as a changed code. But all versions of CPT 2005 show the same words that 86586 has always shown - Unlisted antigen, each. Follow New Immunodeficiency-Panel Rules Labs often perform clinical cell analyses to evaluate a patient's immunologic status using methods that involve flow cytometry. To report these immunodeficiency panels, you should use clinical lab codes from the CPT immunology section (86000s), which Medicare pays under the Clinical Laboratory Fee Schedule. "Immunology codes describe quantitative analyses that do not normally require a pathologist's interpretation," Padget says. But sometimes a specific code is not available - that's when you should use 86586. "Use 86586 for an unlisted component of a flow-cytometry or other panel for an immunodeficiency problem," Padget says. "Code 86586 is now the 'not otherwise specified' companion to the B cell, T cell, NK cell, and stem cell total-count immunology codes. Report one unit of 86586 for each unlisted cell-count component of an immunodeficiency panel." Test Your Skills With This Clinical Example See if you can figure out how to use CPT 2005's new and revised immunology codes to report the following scenario: The treating physician orders an immune dysfunction panel for her patient. The lab performs the test that includes CD3 (total T cells), CD4 (helper cells), CD8 (suppressor cells), CD4/CD8 ratio, CD3/HLA-DR, CD8/CD38, CD8/CD28, and CD19 (B cells). The lab reports the results, with no morphologic review by the pathologist and no interpretive report.
New way: Now you should use only immunology codes like 86064 and 86359 for immune-response cell-count studies that don't normally require a pathologist's interpretation - even if the method involves flow cytometry. Based on CPT 2005 code changes, you should use 86586 (Unlisted antigen, each) to report counts for unlisted cell types that are part of an immunodeficiency panel.
Reserve the new flow cytometry codes (88184-88189) for immunophenotyping of hematolymphoid cancers. These studies involve panels of markers that always require interpretation by a pathologist.
(See "Choose the Right Flow Cytometry Codes in 6 Easy Steps - Here's How" in the first article for a full discussion of the new flow cytometry codes.)
What's changed in all versions is that CPT no longer indents 86586 under the "Skin test" code family. "From 1993, when 86586 was new, through 2004, CPT indented the code under 86485 (Skin test; candida), and 'unlisted' was not capitalized in the code definition," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business practices publishing company in Simpsonville, Ky. These CPT conventions meant that the full 86586 definition was Skin test; unlisted antigen, each.
Further, the AMA commented on code 86586 in the context of new immunology codes for B cells, natural killer cells, and stem cells. Under the heading "Immunology Rationale," CPT 2005 Changes: An Insider's View states, "Additionally, unlisted antigen code 86586 has been added and is intended to be reported for each antigen tested."
Don't miss: What does the 86586 change mean? "By removing 86586 from the skin-test family and commenting on the code in its immunology rationale, the AMA is saying that we should use 86586 for unlisted cell-types in immunodeficiency panels," Padget says. "The AMA's in-house coding advisers confirm that this is how we're to use 86586 today."
CPT has several specific codes to describe individual tests that may be part of an immunodeficiency panel, such as 86359 (T cells; total count). For 2005, CPT added three new cell-count codes:
Tip: Don't mix and match immunology and flow cytometry codes for an immunodeficiency panel. Instead, use specific immunology codes for listed components (such as 86379 for NK cells), and "unlisted" immunology code 86586 for each unlisted panel component. "An immunodeficiency panel involves clinical lab tests, and you should not report flow cytometry codes from the cytopathology section, which are for cancer studies that involve a pathologist's interpretation, for these services," Padget says.
Old way: Before CPT 2005, you would have reported this service using a combination of immunology and flow cytometry codes. "For the CD3 (total T cells), you would have reported 86359," says Laurie Castillo, CPC, CPC-H, CCS-P, owner of Castillo Consulting in Manassas, Va.
You'd have reported 86360 (T cells; absolute CD4 and CD8 count, including ratio) for the CD4 and CD8 absolute counts and ratio; that's the only "bundled" code you have to worry about, then and now. For the other markers (HLA-DR, CD38, CD28 and CD19), you would have reported four units of 88180 (Flow cytometry; each cell surface, cytoplasmic or nuclear marker). Because the test doesn't involve a pathologist's interpretation, you would have used modifier -TC (Technical component) with 88180.
New way: With the CPT 2005 changes, you should report only codes from the immunology section for this immune-dysfunction evaluation panel, Castillo says. You should not use any of the new flow cytometry codes (88184-88189). Report the service this way: 86359, T cell total count (CD3); 86360, CD4 and CD8 absolute counts and ratio; 86064, B cell total count; and 86586 x 3, HLA-DR, CD38 and CD28.
Pathology/Lab Coding Alert
- Choose the Right Flow Cytometry Codes in 6 Easy Steps - Here's How
You can't count on 'per marker' coding for flow cytometry anymore After eliminating 88180 and [...] - Quick Quiz:
Get a Grip on Flow Cytometry Changes for 2005
3 scenarios put your cancer immunophenotyping coding knowledge to the test
Still [...] - Use 86586 for Unspecified Immunology Counts
Don't report flow cytometry for clinical lab tests You'll need to learn a new way [...] - Make Sure You Get Paid for Pre-Diabetes Screening
Modifier -TS ups the frequency ante You've been performing glucose tests to screen at-risk Medicare [...] - You Be the Coder:
Add Up Unique Lab Panel Codes
Question: When a physician orders an evocative/ suppression panel for hormones, the group of tests [...] - Reader Questions:
Document Collection Date for Billing
Question: For blood tests, should our lab report the date of service as the day [...] - Reader Questions:
Diagnosis Is Key for Lipid Tests
Question: Our lab performs regular lipid testing for patients with disorders such as hyperlipidemia. We [...] - Medicare Screens All Patients With Diabetes Risk
But pre-diabetes means more frequent testing Medicare's annual screening coverage applies to those at risk [...] - Reader Questions:
Don't Unbundle Cytology Smears
Question: When the cytotechnologist prepares cerebrospinal fluid for evaluation, we sometimes follow a direct smear [...]
