Pathology/Lab Coding Alert

Correct Coding Initiative (CCI) version 8.3 makes it official: You can't report a separate needle placement code for aspiration and needle biopsy services (FNA and bone marrow) or blood collection. Nor can you report a specific organism or molecular code with a comparable generic code.

"These are not new ideas, but you have to know which codes are flagged in CCI 8.3 to avoid unexpected denials when your lab legitimately performs some of these services together," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, a member of the national advisory board of the American Academy of Professional Coders (AAPC) and president of Physician Coding and Compliance Consulting in Virginia. Although many of the 100-plus pathology and laboratory edit pairs added to CCI Edits represent services that you already know are bundled, you need to know how to override the edits when a physician performs separate, medically necessary services for the same patient on the same day. Needle Placement Doesn't Stand Alone CCI 8.3 pairs a host of needle-placement codes with both FNA codes (10021, Fine needle aspiration; without imaging guidance; and 10022, with imaging guidance) and bone-marrow codes (38220, Bone marrow aspiration; and 38221, Bone marrow biopsy, needle or trocar). The bundled needle-placement services are as follows: 36000* Introduction of needle or intracatheter, vein 36410* Venipuncture, child over age 3 years or adult, necessitating physician's skill (separate procedure), for diagnostic or therapeutic purposes 37202 Transcatheter therapy, infusion other than for thrombolysis, any type (e.g., spasmolytic, vasoconstrictive) 62318-62319 Injection, including catheter placement, cervical or thoracic; or lumbar, sacral (caudal) Nerve blocks for different locations and agents represented by codes 64415, 64417, 64450, 64470 and 64475 90780 Intravenous infusion for therapy/diagnosis, administered by physician or under direct supervision of physician; up to one hour.   Similarly, you cannot report autologous blood collection codes (86890, Autologous blood or component, collection processing and storage; predeposited; and 86891, intra-or post-operative salvage) with some of the aforementioned needle-placement codes. Specifically, CCI 8.3 bundles autologous blood collection with 36000, 36410 and 90780. Most coders know that you would not "unbundle" and separately report the needle-placement portion of an FNA, bone-marrow or autologous blood collection service. "Although clinical situations that require reporting these codes together are uncommon, you have to know how to override the edits if it is medically necessary to perform two of these procedures together for the same patient on the same day," says William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, a laboratory coding and compliance consulting firm in Longwood, Fla.

For example, if the physician or radiologist introduces a needle into the patient's vein for some other therapeutic or diagnostic purpose (e.g., 36000 or 36410) [...]