Health Information Management

Know the new, revised, and deleted 2010 laboratory codes to avoid denials

JustCoding News: Outpatient, February 10, 2010

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Reviewing billing and coding changes for this year will help boost your bottom line and cut denials, says Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CPC-I, CHA, president of Safian Communications Services, Inc., in Orlando, FL. This year brings new codes, new guidance, and some deleted codes and Safian says labs should take note of the numerous changes.

Review these deleted codes
Make the deleted codes the first item on your coding checklist. “That is the No. 1 thing you have to pay attention to,” says Safian.

Many laboratories use preprinted forms that list all the codes so that staff members only have to check a box and submit it to billing. If these forms aren’t updated annually, they may include codes that the AMA removed. When your lab bills for a deleted code, it will automatically get a denial.

“I can’t tell you how many consultations I’ve done where I’ve evaluated a preprinted form and it has CPT codes that were deleted three or four years ago,” says Safian.

Too often, she says those costs are then wrongly passed along to the patient, who ends up paying for the lab’s error. Update the form and remove deleted codes to dramatically reduce denied claims and time spent by staff members chasing those denials, Safian says.

This year, there are several deleted codes, which include the following:

  • 82307: 25 hydroxy vitamin D. Use code 82306 instead. This change also includes a reference to code 82652, dihydroxyvitamin D, 1, 25-. The description for code 82652 has been changed to vitamin D; 1, 25 dihydroxy, includes fraction(s) if performed.
  • 86781: Tredeponema pallidum confirmatory test; (e.g., FTA-abs).

Catch new CPT codes
Failure to update the form to include new codes can mean no money for a newly eligible test, says Safian. New codes are sometimes added, breaking out a component of a previously existing code. If you don’t update your list of codes, you could bill incorrectly and risk denials.

“The fact is, for the investment of a couple of hours and the cost of reprinting preprinted forms for the new year, I can almost guarantee that this will bring forth thousands of dollars in revenue,” says Safian.

Some of the new codes this year are as follows:

  • 83987: A sister code for code 83986, for pH; exhaled breath condensate. In 2009, the code definition for 83986 was pH, body fluid, except blood, with a notation that says “for blood pH see 82800 or 82803.” The notation still stands in 2010, but the new code description is pH; body fluid not otherwise specified.
  • 84145: Procalcitonin (PCT)
  • 84431: Thromboxane metabolite(s), including throboxane if performed, urine
  • 86305: Human epididymis protein 4 (HE4)
  • 86352: Cellular function assay involving stimulation (e.g., mitogen or antigen) and detection of biomarker (e.g., ATP)
  • 86780: Antibody; Treponema pallidum
  • 86825: Human leukocyte antigen (HLA) crossmatch, noncytotoxic (e.g., using flow cytometry); first serum sample or dilution
  • 86826: Human leukocyte antigen (HLA) crossmatch, noncytotoxic (e.g., using flow cytometry); each additional serum sample or sample dilution
  • 87150: Culture, typing; identification by nucleic acid (DNA or RNA) probe, amplified probe technique per culture or isolate, each organism probed
  • 87153: Culture, typing; identification by nucleic acid sequencing method, each isolate, (e.g., sequencing of the 16S rRNA gene)
  • 87493: Clostridium difficile, toxin gene(s), amplified probe technique
  • 88387: Macroscopic examination, dissection, and preparation of tissue for nonmicroscopic analytical studies (e.g., nucleic acid based molecular studies); each tissue preparation (e.g., a single lymph node)
  • 88388: Macroscopic examination, dissection, and preparation of tissue for nonmicroscopic analytical studies (e.g., nucleic acid based molecular studies); in conjunction with a touch imprint, intraoperative consultation, or frozen section, each tissue preparation (e.g., a single lymph node)
  • 88738: Hemoglobin (Hgb), quantative, transcutaneous

Use care with unspecified or unlisted codes
Use new code 89398 (Unlisted reproductive medicine laboratory procedure) with care, says Safian. Don’t use unlisted CPT codes unless absolutely necessary and only with proper documentation, she says.

If you use an unlisted or nonspecified code, include with the claim a report, documentation, or letter. If you don’t include this type of documentation, the insurance company will likely ask for it anyway. Waiting for the company to request it will delay your claim by at least two to three weeks. It costs you labor to have a staff member look up the information and refile the claim.

Go through claims each year to find those that are unlisted or nonspecified and develop a standardized form to submit with each of them, Safian suggests. This will reduce paperwork for staff members and make it more likely that these claims will be paid.

Spot new guidelines
Labs have been instructed to not report two or more panel codes that include two or more tests from the same patient collection if a group of the tests overlap. For example, when a physician orders a general health panel (code 80050), which includes a complete blood count, and the physician also orders an obstetric panel (code 8055), which includes a variety of tests not included in the general panel, but also some of the same tests, this guidance indicates that for the tests that do not overlap, providers should simply bill for them individually.

This prevents payers from paying labs twice for the same test, Safian says. Lab managers might want to consider making a cheat sheet for staff members that includes a table guiding them on panels that have overlapping tests, she says. This shouldn’t be a time-consuming process because there are only 10 panels.

Another new guideline affects codes 86592 and 86780. It states that physicians ordering a treponemal antibody test for syphilis cannot use the obstetric panel code, 86592, which includes a non-treponemal antibody test, says Safian.

You cannot substitute a treponemal test, which has a separate code, 86780, for the non-treponemal test and still bill for a panel, she says. Instead, when a physician orders a treponemal test in addition to the other test on the panel, you must bill all those items separately.

In these instances, avoid the temptation to use modifier -52 for reduced services; it is not permitted for use with pathology panel tests, says Safian. If you are not performing all the tests in the panel, you must bill the tests individually.

Other new guidelines include:

  • When using code 84431 for concurrent urine creatinine determination, there is a parenthetical note that states you should use code 84431 in conjunction with code 82570
  • For transcutaneous hemoglobin measurement, use code 88738

Note these CPT code changes as well:

  • 82784, gammaglobulin, has been changed to (immunoglobulin); the rest of the code description stays the same: IgA, IgD, IgG, IgM, each.
  • 83516 was immunoassay for analyte other than infectious agent antibody or infectious agent antigen, qualitative or semiquantative; multiple step method. For the 2010 code description of code 83516, the semicolon was moved from after the word semiquantative to after the word antigen.
  • 87149: This code used to say culture, typing; identification by nucleic acid probe. The revised code description now says culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed.
  • 88312 had been an add-on code used in conjunction with a surgical pathology code, but is now a primary code. The revised code description also includes "interpretation and report."
  • 88313 is also a former add-on code that is now a primary code. The revised code description also includes "interpretation and report."
  • 88314 now includes an interpretation and reporting requirement.

Be vigilant
Understand the diagnosis codes and double-check to ensure that you have met medical necessity requirements. Look for mistakes on claim forms, such as transposed numbers. For example, Safian once had a coding student who realized one day in class that her physician’s order for an x-ray on a patient’s stomach also listed an inaccurate code for schizophrenia, which had been written in error.

If you, like many managers, and are too crunched for time to review coding and billing changes, delegate the task to someone else. Ideally, you might hire an intern from a local college. You’ll get a student with much training—internships are typically at the end of a college’s coursework—and the intern will get that hands-on training he or she needs.

Editor's note: This article was originally published in the February issue of Laboratory Compliance Insider. E-mail your questions to Senior Managing Editor Dom Nicastro at

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