What Lab Coders Need to Know About CCI 16.0

Look for transcutaneous hemoglobin limitations, and bundling for those new 2010 culture codes.

Think you’re ready to use all those brand new CPT lab codes? Not so fast. You better learn Correct Coding Initiative (CCI) restrictions first, before you start billing Medicare for services using new CPT 2010 codes.

CCI released version 16.0, effective Jan. 1, which includes 24,060 new active pairs and 869 modifier changes, according to Frank D. Cohen, MPA, MBB, senior analyst with MIT Solutions.

Let our experts walk you through the edits that could make billing for some code pairings difficult for your lab.

Block Out Transcutaneous Hemoglobin

CPT 2010 provides a new code for in situ hemoglobin testing: 88738 (Hemoglobin [Hgb], quantitative, transcutaneous). But according to the latest CCI edits, you can never bill 88738 for a patient on the same day that the lab performs any of the following “mutually exclusive” tests:

• 85013 — Blood count; spun microhematocrit

• 85014 —… hematocrit (Hct)

• 85018 —… hemoglobin (Hgb)

• 88740 — Hemoglobin, quantitative, transcutaneous, per day; carboxyhemoglobin

• 88741 —… methemoglobin.

“Because CCI 16.0 lists these bundled codes with a modifier indicator of ‘0,’ you can’t override the edit pair under any circumstances,” says William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Beware CBC bundles: CCI 16.0 also bundles 88738 as a component (column 2) code of the following blood count codes:

• 85025 — Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet count) and automated differential WBC count

• 85027 —… complete (CBC), automated (Hgb, Hct, RBC, WBC, and platelet count).

Since CCI assigns a modifier indicator of “0” to these pairs as well, you won’t ever be able to break the bundles

Problem: Your lab might get requests for two medically necessary hemoglobin tests by different methods in a single day. Based on these new CCI edits, the lab would not be able to bill for both procedures. “For instance, the lab might perform a complete blood count (CBC, such as 85025) for an infant, and based on a low hemoglobin count, perform a transcutaneous hemoglobin later in the day,” Dettwyler says. “With these edit pairs in place, the lab could not bill both procedures.”

Pick 1 Culture Typing Procedure

Your lab might also be ready to use these new CPT 2010 codes for culture typing:

• 87150 — Culture, typing; identification by nucleic acid (DNA or RNA), probe, amplified probe technique, per culture or isolate, each organism probed • 87153 –Culture, typing: identification by nucleic acid sequencing method, each isolate (e.g., sequencing of the 16SrRNA gene).

Watch out: CCI 16.0 places many restrictions on how you can use these codes. Based on the latest edit pairs, you would not expect to report 87150 or 87153 with any other culture typing procedure described by the following codes:

• 87140 — Culture, typing; immunofluorescent method, each antiserum

• 87143 —… gas liquid chromatography (GLC) or high pressure liquid chromatography (HPLC) method

• 87147 —… immunologic method, other than immunofluoresence (e.g., agglutination grouping), per antiserum

• 87152 —… identification by pulse field gel typing

• 87158 —… other methods.

Capture distinct isolates: Although your lab would only use one culture typing technique on a single culture, the lab might perform typing on multiple isolates in a single day. “Labs often process more than one culture from a patient on a single day, such as identifying multiple isolates from a wound culture,” Dettwyler says. When that happens, you might need to report two culture typing methods, such as 87150 and 87140. Because CCI lists these edit pairs with a modifier indicator of “1,” you can override the edit pair by appending modifier 59 (Distinct procedural service) to the column 2 code (87150).

Avoid Method ‘Double Dipping’

If your lab performs an infectious agent antigen detection test using nucleic acid probes (87470-87799, Infectious agent detection by nucleic acid [DNA or RNA] …) you can’t additionally report the new nucleic acid culture typing codes (87150-87153) to describe the lab method, according to CCI 16.0.

“The bundling is common sense,” Dettwyler explains. “87470-87799 describe nucleic acid probes for direct specimens while 87150 and 87153 describe nucleic acid methods for cultures.” The new CCI bundles ensure that you don’t “double dip” these code pairs.

Hurdle: Your lab might process two distinct specimens for the same patient on the same day and legitimately need to report two of the bundled codes. “For example, the lab might process a positive Chlamydia culture (87110, Culture, Chlamydia, any source) by performing a culture typing test such as 87150, and also process a direct smear for gonorrhea on the same day (such as 87591, Infectious agent detection by nucleic acid[DNA or RNA]; Neisseria gonorrhoeae, amplified probe technique),” Dettwyler says.

“Labs need to be alert to this type of bundling restriction and make sure to use modifier 59 to override the edit pair when the lab legitimately performs two bundled tests on two separate pecimens,” he advises.

Watch for molecular diagnostics method bundles:

CCI 16.0 adds a long list of edit pairs to ensure that you don’t list molecular diagnostics steps (from the range 83890-83913, Molecular diagnostics …) to describe procedures your lab follows while performing culture typing (87149-87153).

HLA crossmatch includes flow cytometry methods:

Following the same logic of bundling “method” codes into specific tests that use those methods, CCI 16.0 also adds several edit pairs for the following new HLA crossmatch codes:

• 86825 — Human leukocyte antigen [HLA] crossmatch, non-cytotoxic (e.g., using flow cytometry); first serum sample or dilution

• +86826 —… each additional serum sample or sample dilution (List separately in addition to primary procedure).

The edit pairs bundle 86825 and +86826 with each of the flow cytometry codes 88184-88189. “Labs perform the HLA crossmatch using flow cytometry methods, but you shouldn’t separately report the flow codes because 86825 +86826 are all-inclusive,” Dettwyler says. CCI 16.0 also bundles the HLA codes with B cell (86355) and T cell (86359), because you would not ordinarily quantify B and T cells in addition to an HLAcrossmatch.

Choose 1 Method for pH

CCI 16.0 creates edit pairs for new CPT 2010 code 83987 (pH; exhaled breath condensate). According to the edits, you shouldn’t list 83987 with blood pH (82800), other body fluid pH (83986), or expired gases (94250).

“CCI lists these edit pairs with a modifier indicator of ‘1,’ so you can override the edit pair if the lab performs more than one of these tests on separate specimens on the same day,” Dettwyler says.

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