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Pathology/Lab Coding Alert

You Be the Coder:

CCI Slashes Ability to Separate CBC Edits

Published on Sat Jun 12, 2010

Question: We're using 86356 to bill for CD45RA and CD45RO counts -- should we bill this as one antigen or two?Texas SubscriberAnswer: You should bill two units of 86356 (Mononuclear cell antigen,quantitative [e.g., flow cytometry], not otherwise specified, each antigen) for CD45RA and CD45RO total counts.Here's why: CD45RA and CD45RO represent two distinct antigens. CD45RA is located on Naive helper T-cells and CD45RO is located on Memory helper T-cells. If the lab quantifies each antigen separately to provide diagnostic information, you should code each individually. The code definition states that the unit of service is "each antigen."Caveat: CPT provides many specific codes for total cell counts in the immunology section, such as 86355 (B cells, total count), 86357 (Natural killer [NK] cells, total count), and 86359 (T cells; total count). If you're testing for CD45RA and CD45RO in that context of an immunology study, you are correct to use the not-otherwise-specified [...]
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