Pathology/Lab Coding Alert

Reporting additional studies for culture typing just got more exact. Starting Jan. 1 you'll have new and revised codes to report molecular techniques that your lab performs to classify an isolate beyond the level of  presumptive and definitive identification.

Benefit: The new codes will help you capture pay for culture typing techniques using amplified DNA or RNA probes or nucleic acid sequencing methods.

Prior to Jan. 1, you had one code to report culture typing by nucleic acid probe,and it didn't distinguish between direct and amplified probes: 87149 (Culture, typing; identification by nucleic acid probe).

CPT 2010 revises 87149 to clarify that it describes a direct probe technique, and adds new code 87150 for amplified probe technique. The 2010 codes are as follows:

• 87149 -- Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed

• 87150 -- ... identification by nucleic acid (DNA or RNA) probe, amplified probe technique, per culture or isolate, each organism probed.

Problem: "Prior to 2010, if your lab performed an amplified probe culture technique, such as the BD GeneOhmTM StaphSR Assay for positive blood cultures, you had to report 87149," says Michael Longacre, associate director of corporate reimbursement for BD. The payment was $29.27 (clinical laboratory fee schedulen ational limit amount [CLFS-NLA]).

Problem solved: Now you will report culture typing by nucleic acid probe using 87150. For 2010 payment, CMS crosswalked 87150 to 87798 (Infectious agent detection by nucleic acid [DNA or RNA], not otherwise specified; amplified probe technique, each organism), which currently pays $51.25 (CLFS-NLA). That's a reimbursement increase of $21.98 for each test.

Know when to use 87150: "You should use new CPT code 87150 for indirect specimens from positive cultures, including positive blood cultures that the lab tests via an amplified (PCR/SDA) molecular method" Longacre explains.

CMS 2010 adds another method-specific code for culture typing: 87153 (Culture, typing; identification by nucleic acid sequencing method, each isolate [e.g., sequencing of the 16S rRNA gene]). Use this code when the lab identifies an organism using nucleic acid sequencing techniques rather than a direct or amplified nucleic acid probes. "You would use 87153 to describe a genotypic method for bacterial, mycobacterial, or fungal identification rather than the typical phenotypic or immunologic methods," says Vickie Baselski, PhD, department of pathology,University of Tennessee Health Science Center in Memphis.

An introductory note for the microbiology section instructs coders to separately report appropriate code(s) from the range 87140-87158 when the lab performs additional culture studies beyond the level of definitive identification. In support of new code 87153, CPT 2010 revises the note to add nucleic acid sequencing to the list of possible additional studies. "It's important to note that the AMA placed 87153 with the culture typing codes, which means that you can report the code in addition to initial culture codes for presumptive and definitive identification," Baselski says.

Pricing acknowledges process: Based on the lab methods, CMS crosswalked 87153 to the following series of molecular diagnostics codes that describe the steps involved in the test:

• 83891 -- Molecular diagnostics; isolation or extraction of highly purified nucleic acid, each nucleic acid type (i.e., DNA or RNA) ($5.85)

• 83898 -- Molecular diagnostics; amplification target, each nucleic acid sequence ($24.47)

• 83904 -- Molecular diagnostics; mutation identification by sequencing, single segment, each segment ($24.47)

• 83912 -- Molecular diagnostics; interpretation and  report ($5.85)

• ½ payment of 87900 -- Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics (0.5 x $190.31 = $95.16).

Pricing of 87900is half because 87900 compares multiple nucleic acid sequences to multiple databases while 87153 compares one nucleic acid sequence to the database, according to CMS pricing rationale.Total reimbursement for 87153 based on crosswalking to above codes is $155.80 (CLFS-NLA).

The CPT 2010 microbiology section also sports a new code for C. diff identification:

87493 (Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene[s], amplified probe technique). "Prior to Jan. 1, your only choice to report this test was the generic code 87798 (Infectious agent detection by nucleic acid [DNA or RNA], not otherwise specified; amplified probe technique, each organism)," Longacre says.

Benefit: Because payers sometimes scrutinize not otherwise specified (NOS) codes more carefully and require extra documentation, having a specific code can enhance coverage for a test. "In fact, payers sometimes stop covering non-specific codes if utilization becomes too high," Longacre cautions. "This new code will make billing and claims processing much more efficient for C. diff testing by amplified probe technique."

Payment is steady: The new code won't change payment for the test, according to the CMS decision for CLFS pricing. CMS crosswalked 87193 to 87798 ($51.25, CLFS-NLA).

Don't double dip: Although the new and revised codes 88149-88153 and 87493 involve molecular diagnostics methods, CPT 2010 adds new instructional notes to ensure that you don't bill for the specific code and the underlying molecular diagnostics methods. A new text note in the microbiology introduction and before the infectious agent antigen codes (before 87260) states: "The molecular diagnostic codes (e.g., 83890-83914) are not to be used in combination with or instead of the procedures represented by 87140-87158." Similarly, new notes following 87149, 87150, and 87152 instruct you not to report the code "in conjunction with 83890-83914."

Resource: You can find CMS pricing information in "New Clinical Laboratory Fee Schedule Test Codes And Final Payment Determinations" at www.cms.hhs.gov/ClinicalLabFeeSched/Downloads/CY2010Rationaleaeth-CLEAN.pdf