Attend pathology coding conferences and protect your lab?s payments
Usually, the second quarter is a quiet 1 for CCI edits, but it is not the case this year. There are several new edit pairs that you’ll have to maneuver in the most recent CCI update if you want to defend your lab’s pay. Version 15.1, which went into effect from April 1, has 304,038 additions.
With new limits on code combinations from pathology coding consultations to molecular diagnostics and micro dissections, you want to tackle practically 40 changes in laboratory/pathology alone.
CCI already bundles hundreds of lab codes with pathology consultation 80500 and 80502. The April 1 CCI update continues the tradition by adding edit pairs between 80500/80502 and the following three procedures:
• 86356 – Mononuclear cell antigen, quantitative, not otherwise specified, every single antigen
• 87500 – Infectious agent detection by nucleic acid (DNA or RNA) vancomycin resistance (e.g., enterococcus species van A, van B), amplified probe
• 87809 – Infectious agent antigen detection by immunoassay with direct optical observation adenovirus.
These edits show that you can’t bill Medicare for a pathologist’s medical direction and supervision of clinical lab tests under the guise of an 80500 or 80502.
But that doesn’t mean a pathologist can not charge for an 80500 or 80502 consultation related to lab tests such as these immunology and microbiology procedures. If the physician requests a consultation on an abnormal lab test result and the pathologist renders a professional opinion and files a report, you can go for 80500 or 80502 with any of the bundled lab codes by appending modifier 59 to the consultation code.
To maintain pace with such CCI edits, attempt attending pathology coding conferences and see how they make a difference to your pathology coding career.
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