Pathology/Lab Coding Alert

We'll tell you how to navigate the changes

Starting Jan.1, get ready to change the way you code protein assays. CPT Codes 2004 overhauled the protein codes and added some new coagulation and platelet assays that you'll need to know about too.

CPT Reworks Protein Family

CPT's old protein code family included five codes: 84155, 84160, 84165, 84181, and 84182 with the common code definition of Protein;.... CPT 2004 no longer considers these a code family, removing the indentation and the common portion of the code. The following table shows the new and revised protein codes with indentations as they appear in the code book:

  Status        Code          Definition 
 Revised        84155         Protein, total, except by refractometry; serum   
 New             84156        ... urine 
 New             84157        ... other source (e.g., synovial fluid, cerebrospinal fluid) 
 Revised        84160        Protein, total, by refractometry, any source (for urine total protein by dipstick method, use 81000-81003)  
 Revised        84165         Protein, electrophoretic fractionation and quantitation 
 Revised        84181        ... Western Blot, with interpretation and report, blood or other body fluid 
 Revised        84182       ... Western Blot, with interpretation and report, blood or other body fluid, immunological probe for band  identification, each 

CPT 2004 created a new code family by adding two new codes indented under revised code 84155 as shown in the table. "Under the old code definition [Protein; total, except refractometry], you would have reported 84155 for serum, urine, or 'other source' total protein by other than refractometry," says William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, a laboratory coding and compliance consulting firm in Longwood, Fla.
 
The new codes are good news for labs, Dettwyler claims. "Under the old definition, if the lab performed both a serum and a spinal-fluid protein for the same patient on the same day, you had to use modifier -59 (Distinct procedural service) to indicate that you performed the tests on two different sources, and the second test often went unpaid."
 
Unlike the old definition, refractometry code 84160 is for total protein from any source. "Labs often use refractometry for total protein when they're also performing a protein electrophoresis [84165], so the new code definition better describes clinical practice," Dettwyler says. Codes 84160 and 84165 are no longer part of the 84155 family and are not indented in CPT 2004.
 
With the changes to this section, you might find the indentation of Western Blot codes 84181 and 84182 confusing. "Although CPT 2004 does not indicate a 'revised code' symbol by these codes and still shows them indented, the common portion of the code is unclear," Dettwyler says. Before the revisions, these codes were part of the 84155 code family, indented following "Protein;" as the common code definition. It is unclear if CPT still intends for 84181 and 84182 to be "Protein; Western Blot ..." codes.

Lipoprotein Includes Fractions

Another chemistry code that CPT changed in 2004 is 83716 (Lipoprotein, blood; high-resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed [e.g., electrophoresis, nuclear magnetic resonance, ultracentrifugation]). The modified code adds the clarification "including lipoprotein subclasses when performed."
 
"The definition change just affirms Medicare's prior interpretation that 83716 includes determination of lipoprotein fractions such as LDL and HDL," says Kenneth Wolfgang, MT (ASCP), CPC, CPC-H, director of coding and analysis for National Health Systems Inc., a coding consultation company in Camp Hill, Pa.
 
National Correct Coding Initiative (NCCI) edits already prohibited reporting 83716 with 83718 (Lipoprotein, direct measurement; high-density cholesterol [HDL cholesterol]), 83719 (Lipoprotein, direct measurement; VLDL cholesterol), and 83721 (Lipoprotein, direct measurement; LDL cholesterol). NCCI lists these edit pairs with a modifier indicator of "0," indicating that you cannot override the edit pairs with a modifier.

New Hematology Codes on Two Fee Schedules

CPT 2004 added two new hematology codes that you should know about:
 

 85055 - Reticulated platelet assay
 

 85396 - Coagulation/fibrinolysis assay, whole blood (e.g., viscoelastic clot assessment), including use of any pharmacologic additive(s), as indicated, including interpretation and written report, per day.

The reticulated platelet assay (85055) provides a white blood cell test to help evaluate the cause of thrombocytopenia, just as evaluating reticulocytes (such as 85045, Blood count; reticulocyte, automated) aids in anemia evaluation. The new code provides specificity for labs that perform this test. CMS proposed crosswalking payment for this service to 86361 (T-cells; absolute CD4 count) on the Clinical Laboratory Fee Schedule. The Physician Fee Schedule will include code 85396 because it involves a pathologist's professional interpretation and report.