Pathology/Lab Coding Alert

Correct Coding Initiative (CCI) edits, version 8.2 that took effect July 1, 2002, will remain active until Sept. 30, 2002. "After extensive revision in the April 2002 CCI Edits , pathology Coder get a reprieve this quarter because only a few changes impact their specialty," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, member of the national advisory board of the American Academy of Professional Coders (AAPC) and president of Physician Coding and Compliance Consulting in Virginia. CCI Identifies Inappropriate Coding "CCI edit pairs represent services that are bundled (components of a more comprehensive service) or would not ordinarily be performed together for the same patient on the same day (mutually exclusive services)," Castillo says. Medicare will not reimburse both services when they are reported together.

However, if the two services of a code pair are carried out as distinct and independent services that are medically necessary, Medicare may reimburse with the appropriate modifier. To indicate that codes represent separate services as opposed to unbundling of a single service, append modifier -59 (Distinct procedural service) to override the edit. For clinical lab tests conducted more than once a day, use modifier -91 (Repeat clinical diagnostic laboratory test). Every code pair is assigned a "modifier indicator" of either "1," which means a modifier can be used with the pair, or "0," which means a modifier cannot be used. Practices should ensure that they do not indiscriminately override CCI edit pairs, and that when they do, appropriate documentation exists in the medical record to justify the claim of distinct procedural service. CCI 8.2 Mirrors CPT 2002 Additions/Deletions Version 8.2 pathology edit-pair additions involve two new codes in CPT 2002. Current glucose test codes (82945, 82947, 82948, 82950, 82951, 82952, 82953 and 82962) cannot be reported with the new continuous glucose monitoring service 95250 (Glucose monitoring for up to 72 hours by continuous recording and storage of glucose values from interstitial tissue fluid via a subcutaneous sensor [includes hook-up, calibration, patient initiation and training, recording, disconnection, downloading with printout of data]). Except for 82945 (Glucose, body fluid, other than blood), a "0" modifier indicator for each of the glucose tests means that a modifier will not override the edit pair when any of the codes are reported with 95250.

Similarly, don't report new code 83950 (Oncoprotein, HER-2/neu) with 86294 (Immunoassay for tumor antigen, qualitative or semiquantitative [e.g., bladder tumor antigen]) or 86316 (Immunoassay for tumor antigen; other antigen, quantitative [e.g., CA 50, 72-4, 549], each). "Coders should never list a specific code like 83950 with a code that describes the same service in more general terms, like 86316," Castillo says. But if a lab actually carried [...]