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Pathology/Lab Coding Alert

Stay Ahead of the NCCI Curve With This Consultation Primer

Hint: You'll have to distinguish 80500 and 88321 code families

If you ever bill molecular diagnostics (MD) tests with pathology consults--watch out. National Correct Coding Initiative (NCCI) version 13.1 bundles certain MD codes with consultation codes 80500-80502 and 88321-88325. They-re Here--New Consult Edit Pairs The latest NCCI version bundles 80500 (Clinical pathology consultation; limited, without review of patient's history and medical records) and 80502 (... comprehensive, for a complex diagnostic problem, with review of patient's history and medical records) with these codes:

- 83900--Molecular diagnostics; amplification of patient nucleic acid, multiplex, first two nucleic acid sequences
- 83907--... lysis of cells prior to nucleic acid extraction (e.g., stool specimens, paraffin embedded tissue)
- 83908--... signal amplification of patient nucleic acid, each nucleic acid sequence
- 83914--Mutation identification by enzymatic ligation or primer extension, single segment, each segment (e.g., oligonucleotide ligation assay [OLA], single base chain extension [SBCE], or allele-specific primer extension [ASPE])
- 88384--Array-based evaluation of multiple molecular probes; 11 through 50 probes
- 88385--- 51 through 250 probes
- 88386--- 251-500 probes. You-ll also find that NCCI bundles molecular diagnostics array codes 88384-88386 with codes for consultation on referred material: 88321 (Consultation and report on referred slides prepared elsewhere), 88323 (Consultation and report on referred material requiring preparation of slides), and 88325 (Consultation, comprehensive, with review of records and specimens, with report on referred material).

Prior to version 13.1, NCCI bundled other molecular diagnostics codes from 83890-83913 with the 80500 and 80502 consult codes.

Identify the 3 R's and More for Consultation Codes All consultations require the 3 R-s--request (from treating physician), render (medical opinion) and report (findings). But that's not all you need to know to choose the proper consultation code for you pathologist's service.

Study the following pathology consultation refresher to understand the differences in the consult codes and when you can--or can-t--override the new edit pairs. Know Clinical Pathology Consultation Rules You should select one of the clinical pathology consultation codes (80500 or 80502) when the service meets the following criteria, in addition to the 3 R-s:

- the consultation is for a clinical lab test result
- the consultation follows an abnormal test finding.
 
The breadth of the assessment distinguishes the two codes, with 80502 reserved for cases requiring the pathologist's full review of patient history and records.

Only report the clinical pathology consultation when you meet the following criteria, according to Section 15020-D of the Medicare Carriers Manual:

- The patient's attending physician orders the consultation, not just the underlying lab test. Medicare specifies that standing orders do not satisfy this request requirement.
- The consultant must issue a written report.
- The consultation requires the consulting physician to exercise medical judgment.
- The lab test result behind the consultation must lie outside the clinically significant normal or expected [...]


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