Pathology/Lab Coding Alert

"A rose by any other name would smell as sweet," according to the latest National Correct Coding Initiative (NCCI) edits, version 9.1. Labs have different test methods that supply similar results and you can no longer report many of those tests together. Various codes describe tests for the same condition, organism or analyte because different lab methods exist to arrive at the same information or because different payers require diverse codes. More than 160 new pathology and laboratory edit pairs in NCCI 9.1 prohibit reporting these codes together.

"Because labs ordinarily perform just one test method on a specimen to identify a specific organism or condition, these edit pairs should not create a significant coding problem," says William Dettwyler, MT-AMT, coding analyst for Health Systems Concepts, a laboratory coding and compliance consulting firm in Longwood, Fla. But you need to be aware of the NCCI edit pair additions and how to override them if these services legitimately occur together. NCCI 9.1 is effective April 1 through June 30. NCCI Points to Improper Coding Medicare bundles procedures into NCCI edit pairs to indicate that one code is a component of a more comprehensive code, or that a physician would not ordinarily perform both services for the same patient on the same day (mutually exclusive services). "If the physician orders or carries out two medically necessary, distinct services of an NCCI code pair, Medicare may pay for both procedures if you report them with the appropriate modifier," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, past member of the National Advisory Board of the American Academy of Professional Coders and vice president of ambulatory services, Health Revenue Assurance Associates in Chapel Hill, N.C.

"To indicate that codes represent separate services as opposed to unbundling of a single service, append modifier -59 (Distinct procedural service) to override the edit," Castillo says. For clinical lab tests conducted more than once a day, use modifier -91 (Repeat clinical diagnostic laboratory test). You can only override an NCCI edit with a modifier if the code pair shows a "1" in the modifier indicator column. A"0" modifier indicator means that you cannot override the edit pair. Antigen Detection Methods Are Mutually Exclusive NCCI 9.1 adds more than 80 edit pairs to the mutually exclusive list that prohibit reporting together two codes for detecting the same organism. This continues a trend from earlier NCCI edits and adds code pairs for the following organisms: Chlamydia trachomatis

NCCI 9.1 bundles 87270 (Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis) and 87320 (Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquan-titative, multiple step method; Chlamydia trachomatis) with each other [...]