Pathology/Lab Coding Alert

Relying on numerical or alphabetical order to ensure that you find the correct chemistry code? Watch out.

With the new # symbol and other CPT changes, you won't always find specific codes where you expect them -- and using an unspecified code when a specific code is available could compromise your pay.

Notice that new # sign in your CPT book? CPT 2010 introduces the symbol to alert you to an out-of-order code.

The "#" works like a flashing yellow light: Slow down, there might be something unexpected. Rather than moving groups of codes to new sections, the AMA has created another option. "Resequencing makes a lot of sense to avoid renumbering the codes," explained William T. Thorwarth, Jr., MD, in "CPT 2010 Overview" at the CPT and RBRVS 2010 Annual Symposium's opening session in Chicago.

The new system could save you lots of headaches. The old system required you to learn new codes and change requisition forms and software when CPT deleted entire groups of codes and reassigned existing definitions to new numbers, such as cell count changes in past years.

The AMA's also got a new method of relocating an existing out-of-order code. Rather than deleting the code and creating a new number, the AMA will move the code to its more appropriate location and leave a road sign for you. "Where you would expect the code to be, we added references referring to the code's new place," said Peter A. Hollmann, MD, at the RBRVS 2010 Annual Symposium in Chicago in the session "CPT 2010Resequencing Principles."

Example: The AMA wanted to streamline vitamin D coding in 2010 by making the nomenclature more consistent. Past CPT versions listed vitamin D by several names in three different codes: calciferol (82307, revised in 2010), calcifediol (82306, deleted in 2010), and dihydroxyvitamin D, 1, 25- (82652, revised in 2010). You'll find the revised vitamin D coding asfollows:

82306 -- Vitamin D; 25 hydroxy, includes fraction(s), if performed

82652 -- ... 1, 25 dihydroxy, includes fraction(s),if performed

(82307 has been deleted. For 25 hydroxy vitamin D, use 82306.)

Before the revised code symbol for 82652, "we added a new symbol [#] so you readily identify out of number codes," Hollman said.

Numerical order reference helps out: If you turn in CPT 2010 to find 82652 in numerical order, you won't just find it missing. In its place you'll find a note that states: "Code is out of numerical sequence. See 82000-84999."

Beware: Changes Confound Alphabetical Order, Too

When you're coding a chemistry test, you usually assume the code is in alphabetical order by analyte. But that truism will no longer hold true.

Red alert: Not only did the changes leave vitamin D coding out of numerical order, but it's now out of alphabetical order, too. "If you look at the rest of the chemistry codes, CPT lists most analytes in alphabetical order from acetaldehyde (82000) to zinc (84630),"instructs William Dettwyler, MT-AMT, president of Codus Medicus, a coding consulting firm in Salem, Ore. "If you go looking for vitamin D in alphabetical order, you won't find it because it's nestled between cadmium (82300) and calcitonin (82308)."

Cross references help: CPT 2010 helps you find the vitamin D codes by adding a note under vitamin A (84590): "Vitamin D, see 82306, 82652."

Tip: "If you can't find a code for an analyte where you'd expect it in alphabetical order, double check the index to make sure there's not a specific code before using a non-specific code such as 84591 (Vitamin, not otherwise specified)," Dettwyler advises.

One more example: "Don't look for hCG pregnancy tests in alphabetical order either -- they've been miscarried to the end of the chemistry section (84702-84704, Gonadotropin, chorionic [hCG] ...) after zinc," Dettwyler says. You'll find a cross-reference note for "gonadotropin, chorionic" after 82985 (Glycated protein), and a reference in the index under pregnancy test, gonadotropin, and chorionic gonadotropin.