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In with the new-CPT 2004 charged with changes

January 2004

Lisa Miller

CPT 2004 contains numerous changes of interest to pathologists and other laboratorians, including 29 new codes, 20 revised descriptors, a new subsection for reproductive medicine, and updated instructions.

Changes affecting pathologist services were made in hematology and coagulation, cytopathology, and surgical pathology. Changes to clinical laboratory services were made in several areas, including organ- or disease-oriented panels, chemistry, hematology and coagulation, microbiology, reproductive medicine, and other procedures. All code changes became effective Jan. 1.

Organ- or disease-oriented panels

In CPT 2003, the hematology subsection was revised substantially to reflect current hematology methodology and reporting practices. Code 85022 was deleted and code 85025 was revised for reporting a complete blood count and differential white blood cell count.

In CPT 2004, these codes are included in the list of necessary procedures for the general health (80050) and obstetric (80055) panels to direct the user to the appropriate hematology codes to be reported as part of these panels. No other significant changes were made to this section.

Chemistry

An editorial change was made to code 83716 to further clarify that high-resolution fractionation and quantitation of lipoproteins includes the quantitation of lipoprotein subclasses, when performed. The phrase “including lipoprotein subclasses when performed” was added to the descriptor and the word “cholesterols” was removed.

New code 84156 describes total protein measurement in urine by methods other than refractometry, and code 84157 was added to report total protein measurement in other sources, such as synovial fluid and cerebrospinal fluid. The series of codes for total protein measurements (84155, 84160, and 84165) were also revised to distinguish testing by specimen and methodology. Code 84155 now describes total protein measurement in serum by methods other than refractometry. Codes 84160 and 84165 describe protein measurement by specific methods, including refractometry and electrophoretic fractionation and quantitation. A parenthetical reference was also added to direct users to codes 81000 through 81003 for dipstick methods.

Hematology and coagulation

New code 85055 describes a reticulated platelet assay, which is used to assess the production and consumption of platelets in the evaluation of thrombocytopenia. A new instructional note was added after codes 85378 and 85379 to clarify that code 85379 is intended for ultrasensitive and standard sensitivity quantitative D-dimer testing.

Code 85396 describes a laboratory technology for coagulation/ fibrinolysis assessment of the viscoelastic properties of blood clot, which provides additional information to complement individual coagulation tests, such as prothrombin time, partial thromboplastin time, fibrinogen, platelets, and D-dimer. This can aid in determining the etiology of abnormalities in the plasma components that comprise the clotting process and in determining how the abnormalities affect clot stability. Examples of this technology include the Thromboelastogram, or TEG, and Sonoclot.

The code will include the professional interpretation of the service and has been given a total relative value unit of 0.58 for Medicare's resource-based relative value system.

Microbiology

Two new codes were add- ed to describe infectious agent antigen detection of Giardia by immunofluorescence technique (87269) and enzyme immunoassay technique (87329). These additions separate Cryptosporidium from Giardia, providing greater specificity for those using the data generated by these codes.

New code 87660 will allow labs to report detection of Trichomonas vaginalis by direct probe technique. There had been no specific code for this technique.

Existing codes 87040, 87045, 87046, and 87070 were revised to clarify their intent. The word "aerobic" was added to all four descriptors to indicate that the bacterial culture was aerobic. Code 87075 was also revised to include the phrase "except blood."

Cytopathology

Code 88112 was added to the cytopathology section to describe new cellular enhancement technologies that allow concentration and enrichment of cytology specimens.

Cellular enhancement techniques, which are able to concentrate diagnostic material and remove background contaminating debris, can now be used on complicated specimens that could not be evaluated accurately using typical concentration techniques described by code 88108. Examples of such techniques are the SurePath and ThinPrep methodologies.

The professional component has been given a total RVU of 1.76. A cross-reference was also added instructing the user not to report code 88112 with code 88108. When separate specimens are evaluated for the same date of service, modifier -59 should be used to indicate that the services are distinct.

Guideline changes were made to specify the use of codes 88174 and 88175 for reporting automated screening of vaginal or cervical specimens. These codes are used for automated screening procedures using any system of reporting-Bethesda or non-Bethesda nomenclature.

Surgical pathology

Add-on code 88312 was revised to clarify that special stains are appropriately performed and reported in addition to procedures other than surgical pathology. Before CPT 2004, the wording of the codes in the 88312 to 88314 series was interpreted by some to indicate that these codes can only be used in conjunction with surgical pathology specimens. This was not the intent of these codes.

The code descriptor for 88342 was modified to reflect current clinical terminology by replacing the word "immunocytochemistry" with "immunohistochemistry." This revision does not change the original intent. A parenthetical reference following code 88342 directs users to the appropriate code for quantitative or semiquantitative immunohistochemistry.

CPT 2004 separates traditional tumor morphometric analysis from semiquantitative immunohistochemistry. New code 88361 was created to report quantitative or semiquantitative immunohistochemistry for such analyses as hormone receptor and HER2/neu testing. The technical services of 88342 are incorporated into the new code. A corresponding cross-reference has been added to reflect these changes. The professional component has been valued at 1.47.

Tumor morphometry code 88358 was revised to include an example of the type of procedure that would be reported with this code-for example, DNA ploidy. The instructional note that follows directs the user to not report code 88313 with 88358 for the same service. The professional component has been revalued. The 2004 Medicare physician fee schedule final rule included a publishing error in the relative value units for this service, which will be corrected prior to implementation. The revised professional component value is expected to be approximately 2.00.

Other procedures

Code 89055 was revised to clarify that it describes an assessment for the presence of leukocytes, rather than a quantitative leukocyte count, performed on a fecal specimen. To clarify that this is not a quantitative test, the revised descriptor includes the words "qualitative or semiquantitative."

New codes 89220, 89225, 89230, 89235, and 89240 are simply a renumbering of old codes 89350, 89355, 89360, 89365, and 89399.

Reproductive medicine

A new heading was added to capture new technology and reflect evolving reproductive medical practices. The new section groups reproductive medicine procedures for oocyte/embryo culture and fertilization techniques (89250, 89251, 89268, 89272, 89280, and 89281), oocyte/ embryo biopsy techniques (89290 and 89291), and freezing, thawing, and storage techniques (89258, 89259, 89335, 89342, 89343, 89344, 89346, 89352, 89353, 89354, and 89356). These nonphysician procedures are performed in highly specialized clinical laboratories and should be reported separately from additional physician services.

Category III

Codes 0058T and 0059T were added to describe cryopreservation of ovarian tissue and oocytes.

HCPCS codes

Two new Healthcare Common Procedure Coding System codes to permit billing of common bundled CBC testing services without a platelet count were added to CPT 2004. Labs performing a complete automated CBC without a platelet count and an automated differential WBC count may now bill for it using code G0306. This code was crosswalked to CPT code 85025. Labs should use code G0307 to report a complete automated CBC without a platelet count, which was crosswalked to CPT code 85027.


Complete descriptors for the new and revised codes listed here can be found in the 2004 version of the CPT book. CPT is copyrighted by the American Medical Association. Call the AMA at 800-621-8335 or log on to www.amapress.com to purchase the CPT book. Lisa Miller is CAP policy representative, professional and economic affairs, Washington, DC.