Pathology/Lab Coding Alert

Question: We used to bill Medicare for fecal leukocyte exams using G0026, but that code was deleted. We began reporting the service using 89055, but now we're getting denials. How should we report this procedure?

Texas Subscriber

Answer: Medicare deleted G0026 (Fecal leukocyte examination) effective Jan. 1, 2003. At the same time, CPT added code 89055 (Leukocyte count, fecal), and many labs presumed that it was an appropriate code for the same procedure. In fact, the AMA states in CPT Changes 2003, An Insider's View that "new code 89055 correlates with HCPCS Level II G code G0026, fecal leukocyte examination."
 
But Medicare announced in program memorandum AB-03-127 that beginning Oct. 1, 2003, certain labs that perform the wet-mount fecal leukocyte exam should report the service as Q0111 (Wet mounts, including preparations of vaginal, cervical or skin  specimens) instead of G0026.
 
What's going on here? The issue is Clinical Laboratory Improvement Amendments (CLIA) certification, according to CMS. Labs with provider-performed microscopy (PPM) CLIA certification can only perform PPM- or CLIA-waived-level tests. Although G0026 described such a test, 89055 does not, because the fecal leukocyte exam permitted for a PPM procedure certificate does not include a fecal leukocyte count.
 
Because CLIA regulations allow PPM-certified labs to perform wet-mount examinations, CMS instructed such labs to report the fecal leukocyte exam with Q0111 for dates of service on or after Jan. 1, 2003.
 
Does that mean you'll see an adjustment on all of your claims? No - CMS says, "Contractors need not search their files to either retract payment or retroactively pay claims; however, contractors should adjust claims if they are brought to their attention."
 
You can access the CMS program memo at www.cms.gov/manuals/pm_trans/AB03127.pdf.