Andrew Posted Thu 07th of May, 2020 11:08:31 AM
Hello, the question is a 2 part question. What is the actual clinical rationale that CCI edit says CPT 87150 is incidental to 87581 and 87486? In other words, what is the reason that CCI edits says they are incidental in the first place? AND - what is the criteria that the lab would have to meet to unbundle them and append -59 modifier?
SuperCoder Answered Fri 08th of May, 2020 09:12:25 AM
Incidental is defined as a procedure carried out at the same time as a primary procedure but is not clinically integral to the performance of the primary procedure and therefore, should not be reimbursed separately.
(Incidental procedures require little additional provider resources and are not generally considered necessary to the performance of the primary procedure. An incidental procedure is not reimbursed separately on a claim. Incidental services includes procedures that can be performed along with the primary procedure but are not essential to complete the procedure. They do not typically have a significant impact on the work and time of the primary procedure. Incidental procedures are not separately reimbursable when performed with the primary procedure)
If your lab performs an infectious agent antigen detection test using nucleic acid probes (87471-87801, Infectious agent detection by nucleic acid [DNA or RNA] …) you can’t additionally report the nucleic acid culture typing codes (87150-87153) to describe the lab method.
87471-87801 describe nucleic acid probes for direct specimens while 87150 describe nucleic acid methods for cultures. The CCI bundles ensure that you don’t “double dip” these code pairs.
You can code CPT 87150 with 87581 and 87486, if medical record justifies the medical necessity. 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 mycoplasma pneumoniae on the same day (such as 87581, Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma pneumoniae, amplified probe technique).
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 specimens.
Hope this helps!