Chromosome Analysis Coding: Why the 88220 Denials?

Human chromosomes with color added. Source: NIH

Question: We didn’t receive payment for an 88280 charge because we did not bill it with a “base procedure,” according to the denial. Can you explain the rejection? How could we avoid future denials?

Answer: Your original bill either missed the base  chromosome analysis procedure, or incorrectly listed the base procedure as 88280 (Chromosome analysis; additional karyotypes, each study) instead of the more specific code from 88261-88269.

Tricky: Although CPT does not list 88280 with a “+” to designate that it is an add-on code, it functions as an add-on. Cytogenetic codes 88230-88299 are “building block” codes. You should select the appropriate codes in the range that describe each step that your lab performs for a complete cytogentic study.

For instance, you might report:

• 88237 (Tissue culture for neoplastic disorders; bone marrow, blood cells) for the tissue culture step

• 88261 (Chromosome analysis; count 5 cells, 1 karyotype, with banding) for the first karyotype analysis, and

• 88280 for one additional karyotype analysis. Because 88280 states “additional karyotypes,” you should use the code only with a base code that describes the first karyotype(s) (88261-88269).

What? Add-on codes in disguise? Coding lab and pathology is tough, and here’s where to get the latest.

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