CXZook
Contributor
chapter 10, section F # 8 states "If one laboratory procedure evaluates multiple genes using a next generation sequencing procedure, the laboratory shall report only one unit of service of one genomic sequencing procedure, molecular multianalyte assay, multianalyte assay with algorithmic analysis, or proprietary laboratory analysis CPT code. If no CPT code accurately describes the procedure performed, the laboratory may report CPT code 81479 (unlisted molecular pathology procedure) with one unit of service or may report multiple individual CPT codes describing the component test results when medically reasonable and necessary. Procedures reported together must be both medically reasonable and necessary (e.g., sequencing of procedures) and ordered by the physician who is treating the beneficiary and using the results in the management of the beneficiary's specific medical problem."
It throws me for a loop when it says or may report multiple individual CPT codes describing the component test results. This policy has been brought to my attention when reviewing a denial, we recently received.
Our provider ordered a Quest lab test of JAK2 V617F Cascading reflex to CALR, JAK2 Exon 12, MPL, and CSF3R (NGS procedure). Reporting for this test is done in a stepwise fashion. Once a pathogenic or MPN associated mutation in a target gene is identified the remainder of the genes are not reported or billed. In our patient no identification was done therefore we billed CPT 81270, 81219, 81279, 81339, and 81479. This was denied and the NCCI policy was referenced, and I agree we should have billed CPT 81479 because this was one procedure, using NGS, evaluating multiple genes. But when is it appropriate to report multiple CPTs? Our providers do have the ability to order separately for example JAK2 Exon, MPL, & CALR in this scenario wouldn't we be allowed to bill 81279, 81339, and 81219 separately? These would be individual components and not one procedure, at least that is what I am thinking.
It throws me for a loop when it says or may report multiple individual CPT codes describing the component test results. This policy has been brought to my attention when reviewing a denial, we recently received.
Our provider ordered a Quest lab test of JAK2 V617F Cascading reflex to CALR, JAK2 Exon 12, MPL, and CSF3R (NGS procedure). Reporting for this test is done in a stepwise fashion. Once a pathogenic or MPN associated mutation in a target gene is identified the remainder of the genes are not reported or billed. In our patient no identification was done therefore we billed CPT 81270, 81219, 81279, 81339, and 81479. This was denied and the NCCI policy was referenced, and I agree we should have billed CPT 81479 because this was one procedure, using NGS, evaluating multiple genes. But when is it appropriate to report multiple CPTs? Our providers do have the ability to order separately for example JAK2 Exon, MPL, & CALR in this scenario wouldn't we be allowed to bill 81279, 81339, and 81219 separately? These would be individual components and not one procedure, at least that is what I am thinking.