Pathology/Lab Coding Alert

See how 0500T changes HPV coding, and more.

An emerging technology for cadaver donor lung perfusion may get some wind in its sails now that CPT^® 2018 provides new codes for the procedure.

Problem: Preserving donor lungs "on ice" restricts the donor pool and time available to transplant.

Now pathologists and other clinicians may be involved in a new procedure to keep cadaver lungs in a sterile field in a near-physiologic state, warm and perfused with blood, to help prolong the transplant viability period and broaden the donor pool.

Check Out New Codes

CPT^® 2018 provides the following two new codes to describe these ex-vivo lung perfusion (EVLP) procedures for cadaver donor lungs:

• 0495T (Initiation and monitoring marginal (extended) cadaver donor lung(s) organ perfusion system by physician or qualified health care professional, including physiological and laboratory assessment (eg, pulmonary artery flow, pulmonary artery pressure, left atrial pressure, pulmonary vascular resistance, mean/peak and plateau airway pressure, dynamic compliance and perfusate gas analysis), including bronchoscopy and X ray when performed; first two hours in sterile field)
• +0496T (... each additional hour (List separately in addition to code for primary procedure)).

Notice that these are CPT^® Category III codes. "The need for these codes [arose] due to the development of new technology," says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the Hospital of the University of Pennsylvania.

There's more: The following other new Category III code might also find its way into your laboratory - 0500T (Infectious agent detection by nucleic acid (DNA or RNA), Human Papillomavirus (HPV) for five or more separately reported high-risk HPV types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) (ie, genotyping)).

Make sure to distinguish this code from the following existing codes for high-risk Human Papilloma Virus (HPV) detection:

• 87624 (Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68))
• 87625 (...Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed).

To clarify proper use of these codes, CPT^® 2018 adds these notes following the 0500T entry:

• For reporting four or fewer separately reported high-risk HPV types, see 87624, 87625.
• For reporting of separately reported high-risk HPV types 16, 18, and 45, if performed, use 87625.
• Do not report 0500T in conjunction with 87624 or 87625 for the same procedure.

Understand Category III

Category III codes (also known as "T-codes") are temporary codes for emerging services. Using the Category III code allows for the collection of specific data about use, efficacy, and outcomes.

Rule: "If a Category III code is available, this code must be reported instead of a Category I unlisted code," CPT^® guidelines in the Category III Codes section state.

From a billing standpoint, keep in mind that Category III codes often apply to services that payers consider investigational/experimental. "This means you may not get reimbursed for the procedure," says Jim Pawloski, BS, MSA, CIRCC, R.T. (R)(CV), coder at William Beaumont Hospital in Royal Oak, Michigan, and Adreima in Phoenix, Arizona.

Check expiration: Remember that Category III codes have an expiration date, typically after five years. CPT^® either converts them to a Category I code before that date, or archives them. "If you use Category III codes, you need to check each year to ensure that they are still valid," says Terri Brame Joy, MBA, CPC, COC, CGSC, CPC-I, director of operations with Encounter Telehealth in Omaha, Nebr.