Health Information Management

Note major updates to pathology and laboratory section

JustCoding News: Outpatient, February 8, 2012

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Coders can find the largest number of new codes in the pathology and laboratory section of the 2012 CPT® Manual. The AMA added a total of 103 new codes, 101 of which denote Tier 1 and Tier 2 molecular pathology procedures.

In addition, the AMA deleted two codes and revised five additional codes.

Molecular pathology guidelines
Molecular pathology procedures are lab procedures that analyze nucleic acid to detect variations in genes that may indicate constitutional disorders or somatic (e.g., neoplasm) conditions. These tests may also be used to test for histocompatibility antigens.

"The codes are based on the analyte or the gene-to-gene variant and not on the technology or the methodology that was used to determine the result," says Christi Sarasin, CCS, CCDS, CPC-H, FCS, principal of Sarasin Consulting Group in Friendship, MD.

The CPT Manual uses the Human Genome Organization-approved gene names. The code descriptors also include proteins or diseases associated with the genes—for example, code 81228, Cytogenomic constitutional (genome-wide) microarray analysis; interrogation of genomic regions for copy number variants (e.g. Bacterial Artificial Chromosome [BAC] or oligobased comparative genomic hybridization [CGH] microarray analysis).

When an abbreviation represents a gene name, the abbreviation appears first in the code description, followed by the complete gene name in parentheses. One example is code 81240, F2 (prothrombin, coagulation factor II) (e.g., hereditary hypercoagulability) gene analysis, 20210G>A variant.

The molecular pathology guidelines note that coders should separately report any procedures performed prior to cell lysis, such as microdissection.

Some tests require a physician or other qualified healthcare professional to interpret results. When providers only perform the interpretation, coders should append modifier -26 (professional component) to the specific pathology code.

The CPT Manual also includes an extensive list of definitions for molecular pathology that can assist coders. Coders will find additional instructional parenthetical notes and cross-references throughout the section.

Molecular pathology codes
The molecular pathology procedure codes are divided into two subsections: Tier 1 and Tier 2 codes. Tier 1 (codes 81200-81383) includes 92 codes that represent gene-specific and genomic procedures.

"The code instructions clarify that these codes are stand-alone and should not be used with what is otherwise referred to as stacking codes," says Sarasin.

Tier 2 includes nine codes (81400–81408) that describe molecular pathology procedures not listed in Tier 1. These codes are categorized according to the level of technical resources and interpretive professional work required.

The tests associated with these codes are usually performed less frequently than Tier 1 procedures. Coders should report the appropriate Tier 2 code that includes the specific gene being analyzed, Sarasin says. Each Tier 2 code lists between one and 20 analytes.

"Tier 2 codes represent different ways to test for the same variants, but they have an escalation in the work and the practice expense to capture the analyses," Sarasin says.

Currently, Tier 2 codes represent 80 analytes. "As the section matures, it is anticipated that these nine Tier 2 codes will have over 1,000 analytes incorporated in them," says Sarasin, who attended the AMA's annual CPT symposium.

During the symposium, representatives from the AMA stated that the codes for the molecular pathology chapter will include even more analytes, she notes. It will also include more information in the introduction as well as additional definitions. The AMA also plans to include language that is specific to coders versus providers, she says.

If the analyte tested is not represented by a Tier 1 code or listed under a Tier 2 code, coders should report the appropriate methodology code (codes 83890–83914 and 88384–88368).

Other laboratory and pathology changes
Coders will find two other new codes in the laboratory and pathology section:

  • 86386, Nuclear Matrix Protein 22 (NMP22), qualitative. The AMA established this code in the immunology subsection to report qualitative nuclear matrix testing. This testing was previously reported using code 86294. NMP is found in all patients; however, it is high in patients with bladder cancer, Sarasin says.
  • 87389, Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result. This code is included in the microbiology subsection.

The AMA also revised five codes in the laboratory and pathology section of the 2012 CPT Manual.
Code 86703 now includes the word "result" instead of "assay." A cross-reference following code 86703 has been added to direct coders to report code 87389 for HIV-1 antigen(s) with HIV-1 and HIV-2 antibodies, single result. "This test uniquely detects HIV antibodies approximately one to three weeks earlier than current antibody tests," Sarasin says.

The AMA updated the existing cross-reference following code 86703 to include code 87389 and deleted the reference to the term "antibody."

The AMA also revised codes 88312, 88313, 88314, and 88319 to accomplish the following:

  • Create better definitions for the special stain codes
  • Eliminate confusion regarding special stains where procedures overlap two code definitions
  • Revise existing instructional notes and add new ¬instructional and cross-reference parenthetical notes to create a defined hierarchy for codes 88314 and 88319
  • Define units of service

These codes represent a newly defined hierarchy for surgical pathology special stains, says Sarasin. With the exception of code 88314, the codes are divided into these three groups:

  • Group 1 (88312), which is used to identify microorganisms
  • Group 2 (88313), which is used to identify other (e.g., iron, trichromes), which are not microorganisms or enzymes
  • Group 3 (88319), which is used to identify enzyme constituents

The stains in group 1 and 2 are always paraffin embedded. The stains for group 3 can be frozen block or paraffin embedded.

Code 88314 does not belong to any group. It represents a frozen block to preserve certain elements, such as a muscle biopsy, Sarasin says.

Finally, the AMA deleted two codes for 2012: 88107 (cytopathology, fluids, washings or brushings, except cervical or vaginal; smears and filter preparation with interpretation) and 88318 (determinative histochemistry to identify chemical components [e.g., copper, zinc]).

Editor’s note: This article was originally published in the February issue of Briefings on APCs. E-mail your questions to Senior Managing Editor Michelle A. Leppert, CPC-A, at

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