Pathology/Lab Coding Alert

Question: Our lab is performing a genetic test for warfarin responsiveness for certain patients as part of a clinical trial -- how should we code the service?

Wisconsin Subscriber

Answer: You should report G9143 (Warfarin responsiveness testing by genetic technique using any method, any number of specimen[s]). The test looks for genetic markers to predict the body's  response to warfarin. It is a new type of analysis called "pharmacogenomics testing."

Limitations: Medicare covers pharmacogenomic testing to predict warfarin responsiveness only "in the context of a prospective randomized, controlled clinical study when that study meets certain criteria as outlined in the Medicare National Coverage Determinations (NCD) Manual, Chapter 1, Section 90.1," according to MLN Matters article MM6715 (revised). According to the article, testing is covered if the beneficiary meets three conditions:

1. Is a candidate for anticoagulation therapy with warfarin

2. Has not been previously tested for CYP2C9 or VKORC1 alleles (the alleles warfarin responsiveness is limited to)

3. Has received fewer than five days of warfarin in the anticoagulation regimen for which the provider orders testing.

Medicare covers the test only once in a beneficiary's lifetime, "unless there is a reason to believe that the patient's personal genetic characteristics would change over time," the article states.

Report this: Your lab would need to report the testing using V70.7 (Examination of participant in clinical trial), the eightdigit clinical trial number, and modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study) in addition to procedure code G9143.

You can read more about this topic at www.cms.gov/MLNMattersArticles/downloads/MM6715.pdf.

Correction: The answer to "You Be the Coder: Distinguish 1-Sided Hip Joint Resection" on page 46 of Pathology/Lab Coding Alert Vol. 11 No. 6 incorrectly identifies decalcification as +88331. The correct code is +88311, as properly identified earlier in the same answer.

Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of Doctors' Anatomic Pathology Services in Jonesboro, Ark.