Pathology/Lab Coding Alert

code from the 87140 family (Culture typing; ...) " Castillo says. These codes include some of the same detection methods such as immunofluorescent technique and nucleic acid probe.

3. Select Lab Method First
 
Once you know that you're coding antigen detection from a primary source you should first identify the lab method to help you select the proper code. Infectious agent antigen detection codes fall under four basic techniques each of which forms a family of codes. Each family shares a common code portion preceding the semicolon that describes the method as shown in the codes below:

 

 87260 - Infectious agent antigen detection by immunofluorescent technique; adenovirus
 Coders may see tests in this family described as "(organism name) by DFA " or "(organism name) by immunofluorescence."
 

 87301 - Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative multiple step method; adenovirus enteric types 40/41
 
Labs may describe tests from this family as "(organism name) by EIA technique."
 

 87470 - Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and Bartonella quintana direct probe technique
 

 87471 - ... amplified probe technique
 

 87472 - ... quantification
 
"Notice that the nucleic acid technique typically lists three codes for each organism - direct probe technique amplified probe technique and quantification " Castillo says. Be sure to select the proper code based on this information whether the test is called a DNA probe an RNA probe or a nucleic acid probe.

 

 87802 - Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus group 3
 

 87810 - Infectious agent detection by immunoassay with direct optical observation; Chlamydia trachomatis
 
Labs may describe these tests as "optical immunoassay." The key for these codes is that the lab makes the determination based on some visual observation such as a color change.

4. Select the Organism Next
 
Once you've identified the lab method used you'll need to know the name of the organism the lab tested for. Look under the lab-method parent code and find the organism name. CPT lists the organisms in alphabetical order under the parent code. For example after parent code 87260 you will see listings for 87265 (... Bordetella pertussis/parapertussis) in alphabetical order through 87290 (... Varicella zoster virus). "You'll have to look line by line for the infectious agent because you won't always find these codes by looking up the organism in the index " Castillo says.
 
"You won't find the exact same list of organisms under each method because different lab tests and methods are available for each agent " Castillo says. But you will find some organisms under each method such as Chlamydia trachomatis:

 

 87270 - Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis
 

 87320 - Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative multiple step method; Chlamydia trachomatis
 

 87490 - Infectious agent antigen detection by nucleic acid (DNA or RNA); Chlamydia trachomatis direct probe technique
 

 87491 - ... Chlamydia trachomatis amplified probe technique
 

 87492 - ... Chlamydia trachomatis quantification
 

 87810 - Infectious agent detection by immunoassay with direct optical observation; Chlamydia trachomatis

5. Use General Codes for Unlisted Agent
 
If you know the lab technique but the specific infectious agent isn't listed in that code family you'll have to report the general code for that technique. Use these codes for organisms that are "not otherwise specified." The general codes for unlisted organisms under each method are as follows:

 

 87299 - Infectious agent antigen detection by immunofluorescent technique; not otherwise specified each organism
 

 87449 - Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative;
 multiple step method not otherwise specified each organism
 

 87450 - ... single step method not otherwise specified each organism
 

 87797 - Infectious agent detection by nucleic acid (DNA or RNA) not otherwise specified; direct probe  technique each organism
 

 87798 - ... amplified probe technique each organism
 

 87799 - ... quantification each organism
 

 87899 - Infectious agent detection by immunoassay with direct optical observation; not otherwise specified
 
"Even if CPT lists the organism under a different lab method you have to assign the 'not otherwise specified' code based on the technique the lab carried out " Castillo says.

6. Use Special Codes for Multiple Organisms

CPT provides specific codes for lab methods that detect multiple organisms with one test:
 

 87300 - Infectious agent antigen detection by immunofluorescent technique polyvalent for multiple organisms each polyvalent antiserum
 

 87451 - Infectious agent antigen detection by enzyme immunoassay technique qualitative or semiquantitative; multiple step method polyvalent for multiple organisms each polyvalent antiserum
 

 87800 - Infectious agent detection by nucleic acid (DNA or RNA) multiple organisms; direct probe(s) technique
 

 87801 - ... amplified probe(s) technique
 
If your lab performs such a test you should report the special multiple-organism code rather than each of the individual codes for the specific organisms. "Reporting two individual infectious agent detection codes when the lab only performed one test is not proper coding " Castillo says. For example if the lab performed a direct-probe test that screens for gonorrhea and Chlamydia you should report 87800 not 87490 (... Chlamydia trachomatis direct probe technique) and 87590 (... Neisseria gonorrhoeae direct probe technique).

7. Don't Unbundle Molecular Diagnostic Techniques

Some of the steps that labs use for infectious-agent detection by nucleic acid are similar to the procedures described by the molecular diagnostics codes (83891-83912). These include processes such as nucleic acid extraction (83891) and amplification (83898). The molecular diagnostic codes correctly describe these step-wise lab procedures for genetic studies.
 
"Some coders have incorrectly reported these molecular steps along with the infectious agent detection code but that is incorrect and amounts to unbundling " says Elizabeth Sheppard HT (ASCP) manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem N.C. "The infectious agent codes include all procedures required to identify the organism."
 
In fact Medicare's National Correct Coding Initiative edits bundle molecular diagnostics codes 83891-83912 with the infections agent detection codes meaning that you cannot report these codes together to describe the same service.

"