Wiki HPV Coding for 2015

[TaHall]

Hello.
I am with a pathology group and we are trying to determine the accurate policies for billing the new 2015 HPV CPT codes. We understand that 87623 is for the low risk panel, 87624 is for the high risk panel, and the 87625 is for the HPV 16 and 18 Genotyping. The confusion comes in when our partnering labs are performing a high risk panel as well as an expanded panel that includes the positive result of one of the test in the expanded panel. For example, the high risk panel consist of types 16,18,31,33,35,39,45,51,52,56,58,59,and 68, and the expanded panel test positive for 52. Can you bill 87624x2 or 87624x1.
Thanks for your time and consideration to this matter.

 

[ctokach]

87624 includes both high and low risk genotypes, if tested. There is an MUE on 87623,87624,87625 for the same date of service that prevent Medicare claims from processing more than one unit and also an NCCI edit to bill either together. For commercial carriers, I have seen the 91 modifier work if the testing is actually performed in two steps though as a reflex, if everything is performed in one assay though I think you would have a compliance issue reporting more than one unit of service.