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  In CPT 2007, something new for nearly all

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January 2007
Feature Story

Ayanna Wooding

Chemistry
Immunology

Microbiology

Cytopathology

Surgical pathology

Other procedures

CPT 2007 reflects the specificity and diversity of assays being performed in the contemporary clinical laboratory. New pathology and laboratory CPT codes were added to the chemistry, microbiology, and immunology subsections. CPT codes reflecting pathologists’ services were revised in the cytopathology and surgical pathology subsections. Molecular pathology enthusiasts will be especially pleased to know that a new code for reporting RNA stabilization methodology has been added for CPT 2007. Yet by far, the majority of new pathology and laboratory-related CPT codes were added to the microbiology subsection, including codes for the detection of Enterovirus, Aspergillus, methicillin-resistant Staphylococcus aureus, and Trichomonas vaginalis infectious agents. Pathologists will be particularly interested in the surgical pathology changes that provide important guidance regarding Mohs micrographic surgery services. The following overview will highlight other interesting pathology and laboratory changes in CPT 2007.

Chemistry

AFP-L3 is a biologic marker linked to the aggressiveness of hepatocellular carcinoma. The ratio of the total AFP to its L3 moiety is of clinical significance. New code 82107 permits reporting of both the total alpha-fetoprotein and the subspecies of total alpha-fetoprotein known as the L3 glycoform.

Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been closely correlated to increased risk of coronary heart disease and ischemic stroke associated with atherosclerosis. Code 83698 was created to report a quantitative measurement of lipoprotein-associated phospholipase A2.

The cross-reference preceding code 83890, Molecular diagnostics; molecular isolation or extraction, was revised to include the entire range of applicable CPT codes for microbial identification. The instructional parenthetical now directs users to infectious agent detection codes 87470–87801.

Ribonucleic acid stabilization (preservation) has been demonstrated to be important for obtaining accurate results in molecular diagnostic assays because of the lability of RNA. Delays experienced in specimen storage, transport, or testing of RNA analytes may significantly compromise test results and negatively affect patient therapeutic and management decisions if subsequent testing is performed on unstabilized specimens. Different laboratories can accomplish RNA stabilization by different chemical or physical means. Thus, new code 83913, Molecular diagnostics; RNA stabilization, was developed to report any method of pre-assay ribonucleic acid stabilization. This code is not intended for post-assay stabilization or storage.

Immunology

The instructional guidelines preceding code 86602 were revised to reflect that when a coding option exists for reporting IgM specific antibodies (e.g., 86632), the corresponding nonspecific code (e.g., 86631) may be reported for performance of either an antibody analysis not specific for a particular immunoglobin class or for an IgG analysis. This serves as a clarification of previously established coding convention within the pathology and laboratory section of CPT.

Two new immunology codes, 86788, Antibody; West Nile virus, IgM, and 86789, Antibody; West Nile virus, were introduced in CPT 2007. Code 86788 allows reporting of qualitative assays for the detection of West Nile virus IgM specific antibodies. Code 86789 should be used to report performance of a nonspecific assay for the West Nile virus.

Microbiology

Organ and bone marrow transplant patients, as well as individuals whose immune systems have been impaired by illness or chemotherapy, are known to be especially susceptible to invasive Aspergillus infections. New code 87305 allows for the specific reporting of Aspergillus infectious agent detection by enzyme immunoassay, or EIA, technique.

Before 2007, Trichomonas vaginalis detection via immunoassay techniques was reported using general method code 87899, Infectious agent detection by immunoassay with direct optical observation; not otherwise specified. Detection of Trichomonas vaginalis antigens by immunoassay with direct optical observation may now be reported with new code 87808.

Code 87498, Infectious detection by nucleic acid (DNA or RNA); enterovirus amplified probe technique, was created to report detection of enteroviral nucleic acid from patient samples using this method. This assay is important in the differential diagnosis of meningitis, particularly cerebrospinal fluid specimens in small children.

Two CPT codes were created this year to report detection of Staphylococcus aureus bacteria using amplified probe techniques. New code 87640 describes detection of Staphylococcus aureus by amplified probe technique. Methicillin-resistant Staphylococcus aureus, or MRSA, is known to cause a large number of nosocomial infections, especially for patients in an intensive care unit. Code 87641 was developed to report methicillin-resistant Staphylococcus aureus by amplified probe technique. An instructional parenthetical was added to instruct users to report 87641 for an assay that detects methicillin resistance and identifies Staphylococcus aureus using a single nucleic acid sequence.

Code 87653 was established to report Streptococcus, group B by amplified probe technique. This procedure provides a mechanism for identifying group B Streptococcus, which is a leading cause of sepsis and meningitis in newborn infants.

Revisions to code 87088, Culture, bacterial; with isolation and presumptive identification of each isolate, urine, allow reporting for testing of each distinct isolate for the bacterial culture of a urine specimen.

After codes 87800, Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique, and 87801, Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe technique, a parenthetical has been added to instruct the user to the appropriate codes (87470–87660) for each specific organism detected by nucleic acid from a primary source. This parenthetical also directs the user to appropriate codes (87797, 87798, or 87799) for one-time detection for each agent of specific infectious agents, clarifying the unit-of-service definition for these codes.

Cytopathology

CPT codes 88106, Cytopathology, fluids, washings or brushings, except cervical or vaginal; simple filter method with interpretation, and 88107, Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears and simple filter preparation with interpretation, were revised to clarify that these codes were created to designate simple filter methods. As confusion has arisen regarding the newer technique of filter transfer, a parenthetical was added to advise users to report the monolayer technique code 88112 when this cellular enhancement technique is used.

Surgical pathology

Mohs micrographic surgery is a technique for removing complex or ill-defined skin cancer with histologic examination of 100 percent of the surgical margins. Coinciding with the revisions to the Mohs micrographic surgery section in 2007, an instructional parenthetical note has been added before code 88302 and after code 88309 to instruct the surgeon not to report codes 88302–88309 on a specimen(s) used in a Mohs surgery procedure. This was done because pathological examination of the specimen is an inclusive component of Mohs micrographic surgery to be performed by the surgeon, and not separately reported by the surgeon. Thus, the onus for correct coding lies with the Mohs surgeon. If a Mohs surgeon submits a specimen to a pathologist, the pathologist is then entitled to report the appropriate codes for the services provided. The Mohs surgeon is proscribed from billing for the Mohs procedure under that circumstance. It would be inappropriate for the Mohs surgeon to report Mohs micrographic surgery codes and submit tissue. However, it is appropriate for the pathologist to code for the services he or she provided.

An exclusionary parenthetical has also been added after CPT code 88314 to preclude reporting this code for routine frozen section stains in addition to the Mohs surgery codes, since routine stains are an inclusive component of the Mohs codes. The user is further instructed to report this code, appended by the modifier –59, for a nonroutine histochemical stain (special stain) performed on frozen tissue.

Other procedures

Code 89060 was revised to report crystal identification by light microscopy of a tissue specimen or body fluid. An exclusionary parenthetical note was added to indicate that code 89060 should not be used for crystal identification on paraffin-embedded tissue. However, code 89060 may be reported when a direct smear is prepared and interpreted from a tissue sample that is subsequently submitted for paraffin embedding.


Ayanna Wooding is CAP manager of economic affairs, Washington, DC.