Pathology/Lab Coding Alert

Question: How should we report the lab analysis and pathologist interpretation for a blood test that evaluates for circulating tumor cells for a patient with metastatic colorectal cancer?

Utah Subscriber

Answer: CPT^® provides the following two codes for the Circulating Tumor Cell (CTC) test and interpretation:

• 86152 (Cell enumeration using immunologic selection and identification in fluid specimen (e.g., circulating tumor cells in blood))
• 86153 (… physician interpretation and report, when required).

Caution: Don’t automatically report both codes. You need to document the request for pathologist interpretation before you should bill 86153 in addition to 86152.

Payment: Medicare pays for the lab test on the Clinical Laboratory Fee Schedule (CLFS) at the national rate of $303.34. On the other hand, Medicare pays for the pathologist’s interpretation on the Medicare Physician Fee Schedule (MPFS) at the rate of $35.28 (using conversion factor 35.9996). You must bill 86153 with modifier 26 (Professional component) for Medicare to pay for the test.

You might see this test ordered for patients with metastatic prostate, colorectal, or breast cancer to aid in patient prognosis. CellSearch is an FDA approved test for CTC.