Wiki Billing more than 1 81479 per DEX Z Code

[CXZook]

Provider ordered 3 separate pathology test CALR Mutation, JAK2 V617F Mutation, MPL Mutation. CALR is reported with CPT 81219, JAK2 V617F is reported with 81270, & MPL Mutation is reported with 81339. However, we are billing this to UHC therefore correct Z code and DEX/MOLDX CPT code must be billed. That means we bill 81479 x3 with revenue code 310 so that correct Z-code is billed on each claim line. Does anyone have claim issues with billing 81479 rev code 310 on 3 separate claim lines? Should I be anticipating denials for 81479 x3? Why do we go from a specific CPT code to an unlisted CPT code?
Billing this seems wrong, 81479 x3 on 3 lines, just curious if anyone else is doing this?

 

[danachock]

Hello CXZook (unable to copy and paste them), just be super kind here; your statement "we are billing this to UHC therefore correct Z code and DEX/MOLDX CPT code must be billed".
Well tell us pathology coders what that statement means. Not everyone understands shorthand / acronyms okay. Or share the link to UHC's website to see what the issue is here okay.
But I am familiar with 81479. There is a MUE of 3 per a day of service. With MAI 3 "date of service".
I do not know why UHC is subjecting your facility to send an unlisted code when a more specific code is allowed. UHC is one of my least favorite insurance companies to deal with all their tutorials on how to code scenarios or denials. It will be an uphill battle.
But if you are required to bill 81479x3 for UHC craziness. You may. You will want to be proactive and add a procedure comment on what testing was performed. Don't call me crazy here. I have done the denial thing and the pathology thing for a long time.
Let me know how this works for you okay and have a great evening,
Dana

 

[CXZook]

Hello CXZook (unable to copy and paste them), just be super kind here; your statement "we are billing this to UHC therefore correct Z code and DEX/MOLDX CPT code must be billed".
Well tell us pathology coders what that statement means. Not everyone understands shorthand / acronyms okay. Or share the link to UHC's website to see what the issue is here okay.
But I am familiar with 81479. There is a MUE of 3 per a day of service. With MAI 3 "date of service".
I do not know why UHC is subjecting your facility to send an unlisted code when a more specific code is allowed. UHC is one of my least favorite insurance companies to deal with all their tutorials on how to code scenarios or denials. It will be an uphill battle.
But if you are required to bill 81479x3 for UHC craziness. You may. You will want to be proactive and add a procedure comment on what testing was performed. Don't call me crazy here. I have done the denial thing and the pathology thing for a long time.
Let me know how this works for you okay and have a great evening,
Dana

Certainly, I apologize for the lack of detail and acronyms.

Below is a snip from UHC.

the DEX Z-Code™ Identifier is a unique 5-character alpha-numeric code associated with certain molecular diagnostics (MDx) tests and is used by certain payers as an adjunct to non-specific CPT codes.

This code is assigned within Palmetto's DEX Diagnostics Exchange (DEX) based on the uniqueness of each test being registered. This code, submitted on a claim, in addition to the CPT code, provides greater clarity to help ensure that both payers and providers clearly understand which test is being ordered, performed, and billed.
When you are on the DEX site you are able to see the Z code along with the recommended CPT code, which sometimes mean billing 81479 instead of the specified CPT code. Seems crazy to me to switch it. Our claim rules typically roll all the 310 revenue codes to 1 claim line when it is the same CPT. But we will have to bill 3 separate lines of 310 rev code 81479 to show each unique Z code identifier. Didn't know if anyone else is dealing with this also.



P.S. never would think you're crazy always look forward to reading your responses (but I feel like I am the crazy one now, so much to this!). Will follow up once UHC ajudicates our claim.