Pathology/Lab Coding Alert

Question: I am billing the professional side only for the following tests: serum protein electrophoresis, immunofixation electrophoresis for serum, urine protein electrophoresis, and urine immunofixation electrophoresis for urine. What are the correct CPT codes, and should I report them with a modifier for the  professional component?

Alabama Subscriber

Answer: The answer to this question changes as we implement CPT 2005. Before the new codes, you reported protein electrophoresis and immunofixation electro-phoresis using just two codes, regardless of the source: 84165 (Protein; electrophoretic fractionation and quantitation) and 86334 (Immunofixation electrophoresis). But CPT changes 2005 this coding by revising 84165 and 86334, and adding two new codes: 84166 and 86335. CPT revises the existing codes to specify that the sample source is serum. The new definitions are:

  84165 - Protein; electrophoretic fractionation and quantitation, serum
  86334 - Immunofixation electrophoresis; serum. CPT also adds the two new codes for the same test but specifies that the source is other fluids such as urine:

  84166 - Protein; electrophoretic fractionation and   quantitation, other fluids with concentration (e.g.,   urine, CSF)
  86335 - Immunofixation electrophoresis; other fluids with concentration (e.g., urine, CSF). To bill for the professional component only, you should know that the two old codes 84165 and 86334 are on Medicare's short list of clinical laboratory tests that involve a professional interpretation, and as such, are paid on the Physician Fee Schedule. Medicare explains that you should report the professional component of these tests by appending modifier -26 (Professional component) to the code when you bill the interpretation separately. You can find this instruction in the Medicare Carriers Manual Part 3 Chapter XV Section 15020 E, available on the Internet at http://www.cms.hhs.gov/manuals/14_car/3b15000.asp#_1_10.
 
Although the MCM list hasn't been updated as of press time, the Medicare Physician Fee Schedule, also available on the Internet at http://www.cms.hhs.gov/regulations/pfs/2005/1429fc.asp, lists new codes 84166 and 86335 with modifier -26 for the professional component of those tests.
 
Expect to report an independent pathologist's interpretation of the new codes using modifier -26, just as you would do for the existing codes.