Rules limit new molecular diagnostics and consultation codes, too If your lab performs infectious agent detection tests for strep (87653) or staph (87640, 87641) or other organisms bearing new CPT 2007 codes, prepare to maneuver many National Correct Coding Initiative edit pairs. You need to know the new codes -- and the bundling rules -- if you want to get paid for your services.
The NCCI, version 13.0, took effect Jan. 1. You can access the edits online at
www.cms.hhs.gov/physicians/cciedits/default.asp. Start Using Organism-Specific Codes CPT provides method-specific infectious agent detection codes for organisms that are -not otherwise specified.- But you should stop using those codes (87798, Infectious agent detection by nucleic acid [DNA or RNA], not otherwise specified; amplified probe technique, each organism; 87449, Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative; multiple-step method, not otherwise specified, each organism; and 87899, Infectious agent detection by immunoassay with direct optical observation; not otherwise specified) for the following organisms/methods that have new CPT codes in 2007:
- 87305 -- Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Aspergillus
- 87498 -- Infectious agent detection by nucleic acid (DNA or RNA); enterovirus, amplified probe technique
- 87640 -- Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, amplified probe technique
- 87641 -- Infectious agent detection by nucleic acid (DNA or RNA); Staphylococcus aureus, methicillin resistant, amplified probe technique
- 87653 -- Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group B, amplified probe technique
- 87808 -- Infectious agent antigen detection by immunoassay with direct optical observation; Trichomonas vaginalis.
Don't Bill Twice for a Single Method Think you can bill for antigen detection by nucleic acid probe and separately code for direct or amplified probe techniques? Think again. NCCI 13.0 bundles new codes 87498, 87640, 87641 and 87653 with both 87149 (Culture, typing; identification by nucleic acid probe) and 87801 (Infectious agent detection by nucleic acid [DNA or RNA], multiple organisms; amplified probe[s] technique).
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, you can report the appropriate CPT code for each test,- Small says.
For example, if the lab tests a throat swab for Streptococcus, group B by amplified probe technique (87653) and also types an isolate cultured from the patient's skin using nucleic [...]
