Wiki 87491, 87591, 87536 vs 81381

[martinkc]

87491, 87591, 87536 hit a CCI edit for 81381 with the PTP Edit Rationale of CPT Manual or CMS manual coding instructions.

87491: Chlamydia trachomatis, amplified probe technique.
87591: Neisseria gonorrhoeae, amplified probe technique.
87536: HIV-1 quant, including reverse transcription, when performed
81381: HLA Class I typing, high res; one allele or allele group, each

Although I can find a policy for the first three CPT codes (Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen Identification Testing), CPT code 81381 is not listed. Although I can find several policies for 81381, it doesn't seem to apply to the first three CPT codes.

What am I missing? Can anyone help?

 

[danachock]

Hi martinkc,
87491, 87591 with 87536 all have a bundling issue with 81381 and "if appropriate" each of them would require an appropriate modifier to be billed with 81381. I did pull up a laboratory catalog for a facility I work for and did find some additional information on 81381 - it states "Multiple genotype tests can be performed on a single specimen after a single extraction. See Multiple Genotype Test List for a list of tests that can be ordered together." I did click that Genotype test link to find there are multiple Genotype Tests available to select from. I am also sharing that link for your review - https://www.mayocliniclabs.com/-/me...nstructions/4/3/D/Multiple_Genotype_Test_List
Hopefully this helps, please reach out if you have additional questions and have a wonderful evening.
Dana Chock, CPC, CANPC, CHONC, CPMA, CPB, RHIT

 

[martinkc]

Hello, @danachock,

I appreciate your response.