Pathology/Lab Coding Alert

Stat sepsis diagnosis uses more of your lab's resources

Plenty of laboratorians agree -- and CMS is listening -- that procalcitonin (PCT) testing in the intensive care unit (ICU) entails far more cost for the lab than prolactin. CMS had "crosswalked" PCT payment to prolactin (84146, Prolactin) for the 2010 clinical lab fee schedule because the two tests use similar methodology. High PCT cost was just one comment CMS heard as part of the pricing reconsideration requests for the following three CPT 2010 codes at the July 22 clinical laboratory public meeting for clinical laboratory fee schedule (CLFS) pricing:

• 84145 -- Procalcitonin (PCT)
• 84431 -- Thromboxane metabolite(s), including thromboxane if performed, urine
• 86352 -- Cellular function assay involving stimulation (e.g., mitogen or antigen) and detection of biomarker (e.g., ATP).

Complexity and Critical Care Cost Labs

Physicians use PCT -- a high complexity test -- for early sepsis diagnosis in critical care patients. Thus, stat processing often means that labs can't run the test in a standard analyzer batch and, in fact,may interrupt existing batches, which decreases efficiency and increases costs.

"We are recommending crosswalking PCT to 83880 (Natriuretic peptide) based on the test complexity and particularly based on its use in a critical care setting," said Vickie Baselski, PhD, department of pathology, University of Tennessee Health Science Center in Memphis and chair of the professional affairs committee for the American Society for Microbiology (ASM).

Other presenters concurred on the 84145 to 83880 crosswalk, and one presenter also recommended crosswalking 84431 to 83880 instead of its current pricing based on 83520 (Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified).

A glance at current pricing shows what your lab might stand to gain if CMS accepts the repricing requests for these codes (based on CLFS 2010 national limit amount):

• 84145 -- $27.76
• 84431 -- $18.54
• 83880 -- $48.62.