Pathology/Lab Coding Alert

Rules limit new immunology and FOBT codes, too If your lab performs lipoprotein quantitation using methods described by new codes 83700-83704, prepare to maneuver many edit pairs. You need to know the new codes--and the bundling rules--if you want to get paid for your services.

The National Correct Coding Initiative, version 12.0, took effect Jan. 1. You can access the edits online at www.cms.hhs.gov/physicians/cciedits/default.asp. New Lipoprotein Methods Stand Alone You’ll need to learn about multiple NCCI Edits established for these new lipoprotein codes:

• 83700--Lipoprotein, blood; electrophoretic separation and quantitation

• 83701--… high-resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (e.g., electrophoresis, ultracentrifugation)

• 83704--… quantitation of lipoprotein particle numbers and lipoprotein particle subclasses (e.g., by nuclear magnetic resonance spectroscopy). Mutually exclusive edit pairs keep you from reporting these codes together. That means labs would not normally perform these procedures together--a physician would order one or the other test.

Requirement: NCCI also bundles each of these new lipoprotein codes with the following three services based on the “more extensive procedure” policy:

• 83718--Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)

• 83719--… VLDL cholesterol

• 83721--… LDL cholesterol. Each of these codes entails direct measurement of a specific lipoprotein fraction; therefore, NCCI considers them a component of the more extensive new procedures (83700-83704) that involve quantitation of multiple lipoprotein fractions.

Experts warn: Because NCCI lists these code pairs with a “0” modifier indicator, you can’t override the bundled tests under any circumstances, says Stacey Hall, RHIT, CPC, CCS-P, RCC, director of corporate coding for Medical Management Professionals Inc. in Nashville, Tenn.

NCCI 12.0 also bundles new lipoprotein codes 83700-83704 with category III code 0026T (Lipoprotein, direct measurement, intermediate density lipoproteins [IDL] [remnant lipoproteins]) based on the “more extensive procedure” policy. The “1” modifier indicator, however, means that you can override the edit pair with modifier 59 (Distinct procedural service) if the lab performs two medically necessary tests on different specimens. Immunology Total Counts Include Flow Cytometry When 2005 CPT code changes earmarked flow-cytometry codes for characterizing hematolymphoid cancers and immunology codes for immunodeficiency studies, NCCI confirmed the separation by bundling flow cytometry codes with total-cell-count codes. Now NCCI 12.0 bundles 88182-88189 (Flow cytometry …) with the following new codes for 2006, which are renumbered cell-count codes:

• 86355--B cells, total count
• 86357--Natural killer (NK) cells, total count
• 86367--Stem cells (i.e., CD34), total count. Last year, NCCI bundled 88182-88189 with codes for B, NK and stem cells that CPT 2006 deleted: 86064, 86379 and [...]