Pathology/Lab Coding Alert

You can only choose 1 code and 1 method

If you want to report infectious agent detection codes with confidence, you'll need to maneuver edit pairs in the latest National Correct Coding Initiative (NCCI) edits, version 10.2. The new bundles reflect common practice -- you shouldn't report both a method and organism code or two different method codes for a single test -- but you'll have to know how to override the edits when you legitimately perform two separate services.

NCCI 10.2 took effect July 1. You can access the edits online at the CMS site http://www.cms.hhs.gov/physicians/cciedits/default.asp.

Think you can bill for antigen detection by immunofluorescent technique and bill separately for an immunofluorescent study? Think again. NCCI bundles code family CPT 87260 (Infectious agent antigen detection by immunofluorescent technique; ...) -- representing identification of 20 organisms from adenovirus to Varicella zoster - with both 88346 (Immunofluorescent study, each antibody; direct method) and 88347 (... indirect method).

Note: See "Infectious Agent Edits: Use Our Chart to Navigate NCCI Lingo" for a complete list of the bundled codes.

Reason: "Infectious agent antigen detection codes in the CPT microbiology section are for tests performed on a primary source, such as serum or stool specimen, and describe both the lab method used and the organism identified," says Larry Small, MS, MT(ASCP), principal consultant with L. Small Associates, a clinical laboratory and anatomic pathology compliance operations and billing specialty company. "For a single test, you should select the single code that most precisely describes these two elements."

Exception: "If the lab performs two separate tests from two separate sources using the same methodology, you can report the appropriate CPT code for each test," Small says.

For example, if the lab tests sputum for Pneumocystis carinii by direct fluorescent antibody (DFA) and on the same day the pathologist performs an IgG immunofluorescent antibody test on a lung biopsy specimen, you should report a separate code for each test. Report 87281 (Infectious agent antigen detection by immunofluorescent technique; Pneumocystis carinii) for the sputum lab test, and 88346 for the lung biopsy immunofluorescent study.

"Now that NCCI bundles these two codes, you'll have to use modifier -59 [Distinct procedural service] to override the edits when the lab performs the tests on two distinct specimen sources," says Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a national billing and management firm in Chattanooga, Tenn.

How about billing together different codes for cytomegalovirus identification, such as 87271 (Infectious agent antigen detection by immunofluorescent technique; Cytomegalovirus, direct fluorescent antibody [DFA]) with 87495 (Infectious agent detection by nucleic acid [DNA or RNA]; cytomegalovirus, direct probe technique)? NCCI says you can't bill these together, which reflects correct coding principles. You have to pick a single cytomegalovirus detection code based on the lab technique.

NCCI 10.2 adds similar edit pairs for other organisms. For example, you cannot report the new CPT 2004 code for Trichomonas vaginalis identification (87660, Infectious agent detection by nucleic acid [DNA or RNA]; Trichomonas vaginalis, direct probe technique) with any other specific method codes for the same organism. Labs may identify Trichomonas vaginalis using other methods such as wet mounts from vaginal secretions (87210, Smear, primary source with interpretation; wet mount for infectious agents [e.g., saline, India ink, KOH preps]), or polymerase chain reaction (PCR) from vaginal swabs or urine (83898, Molecular diagnostics; amplification of patient nucleic acid [e.g., PCR, LCR] single primer pair, each primer pair).

The bottom line: "Labs have many methods available to detect an infectious agent, but they only use one specific method for any given test," Small says. The coding question is -- which method did the lab use? For identification of a single organism, you'll have to assign the correct CPT code based on the lab method.