Question: I am billing the professional side only for the following tests: serum protein electrophoresis, immunofixation electrophoresis for serum, urine protein electrophoresis, and urine immunofixation electrophoresis for urine. What are the correct CPT codes, and should I report them with a modifier for the professional component? CPT also adds the two new codes for the same test but specifies that the source is other fluids such as urine: To bill for the professional component only, you should know that the two old codes 84165 and 86334 are on Medicare's short list of clinical laboratory tests that involve a professional interpretation, and as such, are paid on the Physician Fee Schedule. Medicare explains that you should report the professional component of these tests by appending modifier -26 (Professional component) to the code when you bill the interpretation separately. You can find this instruction in the Medicare Carriers Manual Part 3 Chapter XV Section 15020 E, available on the Internet at http://www.cms.hhs.gov/manuals/14_car/3b15000.asp#_1_10.
Alabama Subscriber
Answer: The answer to this question changes as we implement CPT 2005. Before the new codes, you reported protein electrophoresis and immunofixation electro-phoresis using just two codes, regardless of the source: 84165 (Protein; electrophoretic fractionation and quantitation) and 86334 (Immunofixation electrophoresis). But CPT changes 2005 this coding by revising 84165 and 86334, and adding two new codes: 84166 and 86335. CPT revises the existing codes to specify that the sample source is serum. The new definitions are:
Although the MCM list hasn't been updated as of press time, the Medicare Physician Fee Schedule, also available on the Internet at http://www.cms.hhs.gov/regulations/pfs/2005/1429fc.asp, lists new codes 84166 and 86335 with modifier -26 for the professional component of those tests.
Expect to report an independent pathologist's interpretation of the new codes using modifier -26, just as you would do for the existing codes.