Pathology/Lab Coding Alert

Stat sepsis diagnosis uses more of your lab's resourcesPlenty of laboratorians agree -- and CMS is listening -- that procalcitonin (PCT) testing in the intensive care unit (ICU) entails far more cost for the lab than prolactin. CMS had "crosswalked" PCT payment to prolactin (84146, Prolactin) for the 2010 clinical lab fee schedule because the two tests use similar methodology. High PCT cost was just one comment CMS heard as part of the pricing reconsideration requests for the following three CPT 2010 codes at the July 22 clinical laboratory public meeting for clinical laboratory fee schedule (CLFS) pricing:84145 -- Procalcitonin (PCT)84431 -- Thromboxane metabolite(s), including thromboxane if performed, urine86352 -- Cellular function assay involving stimulation (e.g., mitogen or antigen) and detection of biomarker (e.g., ATP).Complexity and Critical Care Cost LabsPhysicians use PCT -- a high complexity test -- for early sepsis diagnosis in critical care patients. Thus, stat processing often means that labs can't run the test [...]