CCI 18.0: 87389: Pick Just 1 HIV Test Code or Risk Denials   (February 2012)

Update bundles for cytology, special stains. Just as you’re starting to use CPT® 2012 changes in your laboratory, the latest edition of Medicare’s Correct Coding Initiative (CCI) restricts how you can use some of those codes. CCI released version 18.0, effective Jan. 1, revealing 15,530 new active pairs and 6,197 code pair terminations, according to Frank D. Cohen, MPA, MBB, senior analyst with Frank Cohen Group, LLC. Most of the new code pair additions for [...]

Catch Up Your Outpatient Edits to CCI 18.0   (February 2012)

Counting on version 17.3 will put you behind.If you’re used to ignoring new CCI edits for the Hospital Outpatient Prospective Payment Systems (OPPS) because the implementation date lags by a quarter – don’t count on it.Here’s why: CMS has announced that the outpatient code editor (OCE) version 18.0 will include the OCE version 17.3 and the new version 18.0, both of which will be implemented at the same time on Jan. 1. That means you’ll need [...]

Newsbrief: Same Code Assignment Could Cause ICD Confusion   (February 2012)

Some conditions change classification.Ready or not, here it comes. More changes came down the pike for ICD-10, just over a year before you’ll need to implement the new code set in your lab.CMS recently posted the 2012 ICD-10 code update, which not only shows which codes were added, deleted, and revised this year, but also offers information on the new diagnosis coding system, which will be mandatory for all providers as of Oct. 1, 2013.Shift [...]

CCI Policy Manual: 83704: Look for NMR Lipoprotein Limits and Opportunities   (February 2012)

Update your transfusion medicine guidelines, too.You always watch to see how Correct Coding Initiative (CCI) quarterly updates impact your lab, but if you overlook changes to the National Correct Coding Initiative Policy Manual, you could miss lots of coding restrictions and unbundling possibilities that impact your bottom line. Thanks to a Jan. 2012 update, your lab has lots of new rules to face this year. You read about some of those changes in “88342, 88360-88361: [...]

You Be the Coder: Find Dividing Line for ISH Codes   (February 2012)

Question: When our lab performs ISH procedures, we have PhD scientists who give the results of the test. We’ve been told that if our physician medical director reviews a certain percentage of cases, that we can use the 88367 instead of 88271 codes. Is that correct, and if so, what is the required percentage of cases?Tennessee SubscriberAnswer: There is no acceptable percentage of physician (medical director) review that allows you to report in situ hybridization [...]

Reader Question: Prep Your ICD-10 Breast Specimen Coding   (February 2012)

Question: Our pathologists examine lots of breast cases, so we’re trying to prepare for diagnosis coding changes when ICD-10 takes effect, especially for malignancies. What differences should we expect?Virginia SubscriberAnswer: Using ICD-9, your coding options for primary breast neoplasms differ based on sex.For female patients you use 174.x (Malignant neoplasm of female breast), and your fourth digit options relate to anatomic location:174.0 – … nipple and areola 174.1 – … central portion 174.2 – … upper-inner quadrant 174.3 – … lower-inner [...]

Reader Question: 85060: Know Medicare Inpatient Restriction   (February 2012)

Question: Medicare doesn’t pay for 85060 for outpatients. Can I submit this code with a modifier to receive payment?Texas Subscriber Answer: No, a modifier is not available to achieve payment for 85060 (Blood smear, peripheral, interpretation by physician with written report) for Medicare beneficiaries who are outpatients. Medicare will only pay for 85060 for hospital inpatients (place of service 21). You’re most likely to see 85060 as part of a bone marrow case billed as [...]

Reader Question: 88305: Acknowledge Cell Block Units Restriction   (February 2012)

Question: The pathologist interprets two FNA specimens – one from a nodule in the right thyroid lobe, and one from the left thyroid lobe. Examining the aspirates involves concentrated smears from both FNA sites, and one cell block from the right lobe and two cell blocks from the left. How should we code the case?Georgia SubscriberAnswer: This case involves multiple procedures, and you should code some of them separately. You must ensure that the pathology report [...]

Reader Question: KOH Test Stands Alone   (February 2012)

Question: Our lab receives a toenail excision with some attached skin for a fungal test. We examine the specimen using a KOH preparation test. Should we report a surgical pathology tissue exam in addition to the KOH test?Ohio SubscriberAnswer: Because you don’t give any indication that a pathologist performed a gross and microscopic exam apart from the potassium hydroxide (KOH) test, you should not report a surgical pathology exam for skin or an unlisted specimen [...]

CCI Policy Manual: 88342, 88360-88361: Report IHC Per Specimen for Medicare Beneficiaries   (January 2012)

Update your microdissection guidelines, too. Just when Correct Coding Initiative (CCI) policy and CPT® 2012 finally agree on the block as the special-stain code unit of service, CCI takes back its equivalent policy for immunohistochemistry (IHC) stains. CMS’ new NCCI Policy Manual, effective Jan. 1, 2012, includes this and several other policies that will impact coding and reimbursement for your lab. Read on to make sure you’re up to speed on the following changes that [...]