Pathology/Lab Coding Alert

CPT Codes 2005 to replace 88180 with separate technical and professional codes

Prepare to change how you code flow cytometry next year as CPT adds five new codes for these services. CMS unveiled the new codes as part of its public fee-schedule meeting held in July.

Physicians interpret flow cytometry based on multiple markers, but 88180 (Flow cytometry; each cell surface, cytoplasmic or nuclear marker) pays for the interpretation per marker, CMS says. CPT 2005 resolves this coding oddity by eliminating 88180 and providing five new codes to describe flow cytometry.

See "Sneak a Peek at New Laboratory and Pathology Codes" for the new codes. Note that an "x" substitutes for the last digit of each code, which the AMA had not assigned at the time of release to CMS. 

Use Different Codes for Technical, Professional Service

Because each flow cytometry marker requires individual performance by the lab, CPT supplies two new codes for the technical service.

"The new technical codes allow labs to capture the work involved in each marker," says R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark. Use the first code (8818x, Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker) to report the first marker per panel, plus one unit of the second code (8818x, ... each additional marker) for each additional marker.

Unlike the lab's technical work, pathologists don't interpret each marker individually. "Because the pathologist renders a single interpretation covering all markers in a panel, CPT 2005 provides separate interpretation codes - distinct from the technical codes - based on the size of the panel," says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business publication company in Simpsonville, Ky.

The three new interpretation 8818x codes are Flow cytometry, interpretation;

1. 2 to 8 markers

2. 9 to 15 markers

3. 16 or more markers.

Change Your -TC, -26 Reporting

Now if separate billing entities perform the technical and professional components of flow cytometry (88180), you have to append modifier -TC (Technical component) for the lab's technical work, and modifier -26 (Professional component) for the pathologist's interpretation. "Because CPT 2005 will provide separate codes for the technical and professional components, you'll be able to separately bill the lab and pathologist services using different codes rather than applying a modifier to one code [88180] as we'd do today," Padget says.

Example: A facility lab performs four flow cytometry markers for phenotyping a lymphoma. An independent pathologist interprets the panel. Here's how to report this service:

Old Way: The lab bills 88180-TC x 4 for the technical service. The pathologist reports 88180-26 x 4 for the interpretation.

New Way: The lab reports one unit of the first 8818x code (Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker) and three units of the second 8818x code (... each additional marker) for the technical work. For the pathologist's interpretation of the four-marker panel, you should report one unit of the next 8818x code (Flow cytometry, interpretation; 2 to 8 markers).

Look Out for Medicare's Claims-Processing Instructions

Medicare provides reporting instructions for 88180 in the Medicare Claims Processing Manual (Chapter 12, Section 60). Watch for new direction from the agency when the codes change in 2005.

"We've seen some payment problems for procedures such as Pap smears when separate entities bill the distinct technical and professional codes - that is, using two different code sets to denote the professional and technical service, instead of using modifiers - so we'll look to CMS to ensure that this sort of confusion doesn't occur for the 8818x codes," Padget says.