Urology Coding Alert
Decipher the BTA vs. NMP22 Puzzle
Question: In reading the Urology Coding Alert article on NMP22s I have a question. For code 86386, is that used specifically for when a bladder tumor or suspicious area is found? And is code 86294 used for hematuria? I’m just trying to get clarification between the two.
Answer: Codes 86386 (Nuclear Matrix Protein 22 [NMP22], qualitative) and 86294 (Immunoassay for tumor antigen, qualitative or semiquantitative [eg, bladder tumor antigen]) are two qualitative urinary tests that are used as adjuncts for the detection and follow-up of patients with bladder carcinoma.
These tests are not used as screening tests. Code 86294 is used for the billing of the BTA test — an immunoassay for a bladder tumor antigen often found in the urine of patients with malignant bladder tumors. Code 86383 is used for the billing of the NMP22 test — the detection of nuclear matrix protein 22 also found often in patients with malignant bladder tumors.
Payable diagnoses include microscopic hematuria (599.72), carcinoma in situ, bladder (233.7), bladder tumors of unspecified nature (239.4), and personal history of bladder tumor (V10.51). Both of these urinary tests can be performed in an office setting.
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Urology Coding Alert
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