|
Prepare to update how you code MPO and DCP.
From a marker for myocardial infarction (MI) to transcutaneous hemoglobin assessments, next year's CPT update will give your lab more specific codes for up-and-coming diagnostic tests.
Update From Method to Marker
When your lab identifies a disease marker or test that doesn't have a specific CPT code, you have to report the service using a nonspecific code that describes the lab method or a specific Category III code, if available. But you shouldn't keep using the generic-method codes when CPT adds a new, analyte-specific test code, says William Dettwyler, MT-AMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.
That's why you should get ready to change the way you report the following two tests:
1. MPO: Physicians might order serum myleoperoxidase when a patient presents with chest pain but shows a normal EKG and troponin-negative test results.
2009 way: CPT 2009 introduces 83876 (Myeloperoxidase [MPO]) for this test, and you should report the finalized code beginning Jan.1, 2009.
2008 way: For 2008 services, labs use a generic test code based on lab method, such as 83516 (Immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantitative; multiple step method) to describe the test.
2. DCP: To follow patients with chronic liver disease who are at increased risk for liver cancer, physicians might order des-gamma-carboxy-prothrombin to aid in the diagnosis of hepatocarcinoma.
2009 way: CPT 2009 provides 83951 (Oncoprotein; des-gamma-carboxyprothrombin [DCP]) to report DCP after the first of next year.
2008 way: A general code such as 86316 (Immunoassay for tumor antigen, other antigen, quantitative [e.g., CA 50, 72-4, 549], each) is the only way a lab can report DCP until the new code becomes effective in January.
Don't Miss Enzyme Code for Vaginal Infection
A culture may not be the only way to diagnose bacterial vaginosis. Studies show that the presence of a specific enzyme, sialidase, in vaginal fluid can serve as a clinical indicator of bacterial infection. That's why CPT 2009 introduces a new code for the test.
2008 way: Lacking a more specific code, labs must use the catch-all microbiology code 87999 (Unlisted microbiology procedure) to report the test until January 2009, Dettwyler says.
2009 way: You can use 87905 (Infectious agent enzymatic activity other than virus [e.g., sialidase activity in vaginal fluid]) starting Jan. 1.
Capture Blood Function Tests
From coagulation abnormalities to hemoglobin status, CPT 2009 provides new codes for diagnosing certain blood disorders.
Although CPT already provides codes for several functional proteases involved in coagulation, you didn't have a code for additional non-specified factors--until now.
For instance: ADAMTS-13 is a protease that cleaves von Willebrand factor, a large protein involved in blood clotting.
2008 way: Without a code for the functional-activity clotting factor, labs often report ADAMTS-13 as 85246 (Clotting; factor VIII, VW factor antigen).
2009 way: Starting Jan. 1, you should report the ADAMTS-13 activity test by Fluorescence Resonance Energy Transfer (FRET) technology using new code 85397 (Coagulation and fibrinolysis, functional activity, not otherwise specified [e.g., ADAMTS-13], each analyte).
Look for tests without blood draws: For transcutaneous tests that allow physicians to assess the status of certain blood components in vivo, look for the following code changes:
• 88720 -- This code simply replaces existing code 88400 (Bilirubin, total, transcutaneous).
• 88740--This is the first of two new codes to report a transcutaneous test to identify abnormal hemoglobin. Code 88740 is for carboxyhemoglobin, which is associated with carbon monoxide poisoning.
• 88741 --This is the second new CPT 2009 code for a transcutaneous test -- this one for methemoglobin, which is associated with an oxidized heme moiety that could indicate poisoning with a substance such as lidocaine.
Comment on Pricing Proposal by October
CMS made preliminary payment determinations for the new codes after receiving industry input during and following the July 14 public meeting. The comment period on the proposed pricing and rationale lasted until Oct. 10, 2008, according to the CMS posting with contact Glenn McGuirk. You can view the preliminary payment determinations on the Internet at www.cms.hhs.gov/ClinicalLabFeeSched/Downloads/LabCodeCrosswalk2009.pdf.
After allowing more comment, CMS will announce the final pricing in the CY 2009 instruction, which you can find on the CMS Web site at www.cms.hhs.gov/ClinicalLabFeeSched/05_Laboratory_Public_Meetings.asp#TopOfPage. A new, 60-day "reconsideration request" period will allow further comment on final pricing.
Expect crosswalk: Although payment method for codes can be either crosswalk -- paying at the same rate as a comparable existing code -- or gap-fill -- pricing a code based on analysis of annual carrier payment rates -- all presenters at the public meeting recommended crosswalks for all the codes, and CMS's proposal for preliminary payment determination also did not use gap-fill pricing.
|
