Pathology/Lab Coding Alert

Rules limit new immunology and FOBT codes, too

If your lab performs lipoprotein quantitation using methods described by new codes 83700-83704, prepare to maneuver many edit pairs. You need to know the new codes--and the bundling rules--if you want to get paid for your services.

The National Correct Coding Initiative, version 12.0, took effect Jan. 1. You can access the edits online at www.cms.hhs.gov/physicians/cciedits/default.asp.

New Lipoprotein Methods Stand Alone

You’ll need to learn about multiple NCCI Edits established for these new lipoprotein codes:

• 83700--Lipoprotein, blood; electrophoretic separation and quantitation

• 83701--… high-resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (e.g., electrophoresis, ultracentrifugation)

• 83704--… quantitation of lipoprotein particle numbers and lipoprotein particle subclasses (e.g., by nuclear magnetic resonance spectroscopy).

Mutually exclusive edit pairs keep you from reporting these codes together. That means labs would not normally perform these procedures together--a physician would order one or the other test.

Requirement: NCCI also bundles each of these new lipoprotein codes with the following three services based on the “more extensive procedure” policy:

• 83718--Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)

• 83719--… VLDL cholesterol

• 83721--… LDL cholesterol.

Each of these codes entails direct measurement of a specific lipoprotein fraction; therefore, NCCI considers them a component of the more extensive new procedures (83700-83704) that involve quantitation of multiple lipoprotein fractions.

Experts warn: Because NCCI lists these code pairs with a “0” modifier indicator, you can’t override the bundled tests under any circumstances, says Stacey Hall, RHIT, CPC, CCS-P, RCC, director of corporate coding for Medical Management Professionals Inc. in Nashville, Tenn.

NCCI 12.0 also bundles new lipoprotein codes 83700-83704 with category III code 0026T (Lipoprotein, direct measurement, intermediate density lipoproteins [IDL] [remnant lipoproteins]) based on the “more extensive procedure” policy. The “1” modifier indicator, however, means that you can override the edit pair with modifier 59 (Distinct procedural service) if the lab performs two medically necessary tests on different specimens.

Immunology Total Counts Include Flow Cytometry

When 2005 CPT code changes earmarked flow-cytometry codes for characterizing hematolymphoid cancers and immunology codes for immunodeficiency studies, NCCI confirmed the separation by bundling flow cytometry codes with total-cell-count codes. Now NCCI 12.0 bundles 88182-88189 (Flow cytometry …) with the following new codes for 2006, which are renumbered cell-count codes:

• 86355--B cells, total count
• 86357--Natural killer (NK) cells, total count
• 86367--Stem cells (i.e., CD34), total count.

Last year, NCCI bundled 88182-88189 with codes for B, NK and stem cells that CPT 2006 deleted: 86064, 86379 and 86587, respectively.

The new edit pairs send the same message that NCCI sent last year: You should not report both immunology and flow cytometry codes for a single procedure, says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Don’t miss: Nor should you charge for an interpretation service with the total-cell-count codes. The NCCI Policy Manual states, “Quantitative cell counts performed by flow cytometry should not be reported with the flow cytometry interpretation CPT codes 88187-88189 since there is no interpretative service for these quantitative cell counts.”

Choose Only 1 FOBT Method

NCCI 12.0 bundles the new fecal occult blood test (FOBT) code 82272 (Blood, occult, by peroxidase activity [e.g., guaiac], qualitative, feces, single specimen [e.g., from digital rectal exam]) with the following existing FOBT codes:

• 82270--Blood, occult, by peroxidase activity (e.g., guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (i.e., patient was provided three cards or single triple card for consecutive collection)

• 82274--Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations

• G0107--Colorectal cancer screening; fecal-occult blood test, 1-3 simultaneous determinations

• G0328--Colorectal cancer screening; fecal-occult blood test, immunoassay, 1-3 simultaneous determinations.

You can distinguish FOBT codes based on the method (guaiac vs. immunoassay) and number of specimens (single vs. three). You should use a HCPCS Level II code (G0107 or G0328) if the ordering physician states that the FOBT is for colorectal cancer screening or requests the test with a screening code such as V76.51 (Special screening for malignant neoplasms; colon), says Anne Pontius, MBA, CMPE, MT (ASCP), president of Laboratory Compliance Consultants Inc., in Raleigh, N.C.

Bottom line: You must select only one FOBT test code based on the lab method used, the number of specimens, and the reason for the test (screening or diagnostic).

Limit Use of Pathology Consultation

Many pathology procedures include the physician interpretation and report, and you shouldn’t additionally bill a consultation code for those services. That’s why NCCI 12.0 bundles clinical pathology consultation codes 80500 (Clinical pathology consultation; limited, without review of patient’s history and medical records) and 80502 (... comprehensive, for a complex diagnostic problem, with review of patient’s history and medical records) with many new codes.

These include the new immunology codes 86355, 86357 and 86367; new lipoprotein codes 83700, 83701 and 83704; and all of the new codes for nursing facility care and rest home services 99304-99337.