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Wiki Auditing Molecular Pathology Codes

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RARevis

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Does anyone know if there is a designated CPT code for UTI Molecular Pathogen Identification Test Panel? The provider submits a list of what is tested in the panel but then doesn't bill a single panel code. They bill each specimen in the list separately which seems unbundling to me. But I cant deny for unbundling because I can't find a code that incorporates what's tested in the panel. Plus, the lab doesn't list a code that is specific for a UTI molecular pathogen panel.
 
I'm having the same confusion over a "Respiratory Pathogens Molecular Study" - I'm an ancillary coder and the lab is billing all the pathogens and probes separately and I can't find anything that speaks to this but I feel like they're billing it wrong. The study tests for 9 pathogens.
 
What's the methodology being used? The methodology drives the Molecular lab codes. Plus, the CMS NCCI Manual states that a service that provides multiple results via one test is to be billed with the most comprehensive code encompassing what was performed. Usually molecular panels encompassing multiple genes/alleles are covered by 81479 or multiple infectious organisms tested with one test kit would be 87801, depending on methodology. The genetic testing registry can help figure all of this out. https://www.ncbi.nlm.nih.gov/gtr/ Also, many labs are now performing services covered by a PLA or MAA code from Appendix O of CPT but billing each individual organism or gene tested separately on the claim. Hope this helps. I found these older messages by searching for guidance on some of the same issues.
 
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