Download - Coding Laboratory ServicesCoding Laboratory Services AHIMA 2009 Audio Seminar Series 1 Notes/Comments/Questions The Objectives At the conclusion of today’s program, the participants

© Copyright 2009 American Health Information Management Association. All rights reserved.

Coding Laboratory Services

Audio Seminar/Webinar June 4, 2009

Practical Tools for Seminar Learning

Disclaimer

AHIMA 2009 Audio Seminar Series • http://campus.ahima.org/audio American Health Information Management Association • 233 N. Michigan Ave., 21st Floor, Chicago, Illinois

i

The American Health Information Management Association makes no representation or guarantee with respect to the contents herein and specifically disclaims any implied guarantee of suitability for any specific purpose. AHIMA has no liability or responsibility to any person or entity with respect to any loss or damage caused by the use of this audio seminar, including but not limited to any loss of revenue, interruption of service, loss of business, or indirect damages resulting from the use of this program. AHIMA makes no guarantee that the use of this program will prevent differences of opinion or disputes with Medicare or other third party payers as to the amount that will be paid to providers of service.

CPT® five digit codes, nomenclature, and other data are copyright 2009 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT®. The AMA assumes no liability for the data contained herein.

As a provider of continuing education the American Health Information Management Association (AHIMA) must assure balance, independence, objectivity and scientific rigor in all of its endeavors. AHIMA is solely responsible for control of program objectives and content and the selection of presenters. All speakers and planning committee members are expected to disclose to the audience: (1) any significant financial interest or other relationships with the manufacturer(s) or provider(s) of any commercial product(s) or services(s) discussed in an educational presentation; (2) any significant financial interest or other relationship with any companies providing commercial support for the activity; and (3) if the presentation will include discussion of investigational or unlabeled uses of a product. The intent of this requirement is not to prevent a speaker with commercial affiliations from presenting, but rather to provide the participants with information from which they may make their own judgments.

The faculty has reported no vested interests or disclosures regarding this presentation.

Faculty

AHIMA 2009 Audio Seminar Series ii

Betty Hatten, MHS, MT

Betty Hatten is a manager in Huron Consulting Group’s Clinical Research Solutions and Healthcare Compliance practice. Ms Hatten is a 40 year veteran of the healthcare industry, including the past 11 as a healthcare consultant focusing on coding and compliance, charge capture, performance improvement, and chargemaster development and maintenance. A medical technologist for 28 years, her experience includes clinical laboratories, genetics and transplant labs, in vitro fertilization labs, educator, and laboratory administrative director.

Diana Medal, MA, RHIA, CCS, CPC, CCS-P

Diana Medal is a compliance practice leader in the care delivery section of Kaiser Permanente’s national Compliance, Ethics, and Integrity team, where she is responsible for coordinating coding compliance training and supporting coding compliance audits. Ms Medal was previously assistant professor of health information administration at Loma Linda University. She also participated in global distance instruction for Loma Linda, as medical terminology instructor for physical and occupational therapy students in Yokkaichi, Japan.

Table of Contents

AHIMA 2009 Audio Seminar Series

Disclaimer ..................................................................................................................... i Faculty ......................................................................................................................... ii The Objectives ............................................................................................................... 1 The Agenda ................................................................................................................... 1 Comparison of Organ & Disease Panels ............................................................................ 2 Lab Coding Tips ............................................................................................................. 3 Online, Free, Lab Coding Reference ................................................................................. 4 Using the Reference Lab Website .................................................................................... 4 Coding Tip: Always Validate Testing Methods: Labs Vary ................................................... 5 2009 CPT Codes .......................................................................................................... 5-7 HCPCS Code Selection .................................................................................................... 7 Polling Question #1 “Source of Diagnostic Information” ..................................................... 8 Official Coding Guidelines ................................................................................................ 8 Official Coding Guidelines Diagnostic Services Only ....................................................... 9-10 Coding for Physician Billing Pathologist ............................................................................ 10 Proposed New Codes for FY 2010 ................................................................................... 11 Proposed Invalid Codes for FY 2010 ................................................................................ 11 Pathologist’s Interpretation of a Pap Smear ..................................................................... 12 Papanicolaou Test Reconfirmation V72.32 ....................................................................... 12 Abnormal Cytologic Smear of Anus 796.7 ........................................................................ 13 Other Codes Associated with Anal Pap Smear .................................................................. 13 Diagnosis from Ordering Physician vs. Pathologist for Pathologist Claim ............................. 14 Diagnosis for Urine Culture ............................................................................................ 14 Diagnosis for Complete Blood Count (CBC) ...................................................................... 15 Diagnosis for Monitoring Effects of Long-term Use of Drugs .............................................. 15 Clinical Laboratory Fee Schedule ............................................................................... 16-17 Physician Fee Schedule ............................................................................................. 17-18 Reimbursement for OPPS Hospital Lab Tests that are Assigned APCs ................................. 18 Reimbursement for OPPS Hospital Labs ........................................................................... 19 Addendum B: OPPS Reimbursement ............................................................................... 19 Status Indicator Definitions ............................................................................................ 20 Billing for End Stage Renal Disease (ESRD) Related Laboratory Tests ........................... 20-21 Composite Rate Tests .................................................................................................... 22 Polling Question #2 “The Semicolon and Modifiers” .......................................................... 22 National Correct Coding Initiative ................................................................................... 23 Do these 2 Indented Codes Need a Modifier? ............................................................. 23-24 Modifier -59 Distinct Procedural Service ...................................................................... 25-26 Polling Question #3 “Use of Modifier -59” ........................................................................ 26 Modifier -91 Repeat Clinical Diagnostic Test ..................................................................... 27 -59 or -91 Case Study .................................................................................................... 28 Modifier -90 Reference (Outside) Laboratory ................................................................... 29

(CONTINUED)

Table of Contents

AHIMA 2009 Audio Seminar Series

ESRD Modifiers: CD, CE, CF ...................................................................................... 29-30 OIG Work Plan (FY 2009)............................................................................................... 30 Why Doctors Order Lab Tests? ....................................................................................... 31 Information Available for Each “Reason” ......................................................................... 31 The Need for ABNs: Variable .......................................................................................... 32 Screening Tests: Legislative Provisions ............................................................................ 32 Beneficiary Notices Initiative (BNI) ................................................................................. 33 The CMSR 131 ......................................................................................................... 33-34 ABN Instructions and Options ......................................................................................... 34 Guidelines for Coding Blood Transfusions ........................................................................ 35 Complete Billing of the Blood Transfusion ........................................................................ 35 Transfusion Medicine Case: The Facts ............................................................................. 36 Transfusion Medicine Case: The Answer .......................................................................... 36 NCCI Edits for Crossmatching ......................................................................................... 37 Transfusion Medicine Case: The Answer .......................................................................... 37 Most Common “Missed” CPT Codes in Lab: Microbiology ................................................... 38 Aerobic and Anaerobic Cultures with Blood Cultures .................................................... 38-39 Most Common “Missed” CPT Codes in Lab: Microbiology .............................................. 39-40 For More Information on Laboratory Coding from CPT Assistant ................................... 40-41 Resource/Reference List ........................................................................................... 41-42 Supplemental Material ................................................................................................... 43 Other References : Lab Websites .................................................................................... 43 Audience Questions ....................................................................................................... 44 Audio Seminar Discussion .............................................................................................. 44 Become an AHIMA Member Today! ................................................................................. 45 Audio Seminar Information Online .................................................................................. 45 Upcoming Audio Seminars ............................................................................................ 46 Thank You/Evaluation Form and CE Certificate (Web Address) .......................................... 46 Appendix .................................................................................................................. 47 Resource/Reference List ....................................................................................... 48 CE Certificate Instructions


AHIMA 2009 Audio Seminar Series 1

Notes/Comments/Questions

The Objectives

At the conclusion of today’s program, the participants will be able to:

1. Select the most accurate lab CPT/HCPCS code; 2. Locate internet resources for coding esoteric lab

procedures and profiles;3. Identify the appropriate payment programs for OP

lab services including ESRD composite rate, Clinical Lab Fee schedule and OPPS APCs;

4. Discuss CPT coding guidelines for laboratory services;

5. Summarize the ICD-9 CM Diagnostic Coding and Reporting Guidelines for Outpatient Services; and

6. Demonstrate the correct use of modifiers 59 and 91.1

The Agenda

1. CPT & HCPCS Coding Overview with Coding TIPS and CAUTIONS

2. ICD-9 Diagnosis & Procedure Coding3. The Fee Schedules and Addendum B4. Lab Modifier Maze and the NCCI5. OIG & the Clinical Lab: Compliance

Guidelines and the 2009 Work Plan6. Deep Dive into Real Life Lab Coding

Cases2




Comparison of Organ & Disease Panels

3

Comparison of Organ & Disease Panels

4




Lab Coding Tips

Select Accurate 80000 Codes• Adjectives and other important words

• Specimen , Method, Total or Free, With or W/out

• Manual or automated, Qual or Quant, initial,• Each, first, “2-8” or “9-15”• Antibody codes start with 86xxx; Antigens

start with 87xxx

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Lab Coding Tips

• When you need more than one code• Charge explosions • Panels , Profiles and Reflex Tests:

Maintaining Compliance

• When there isn’t a code• Avoid the unlisted procedure code: Use

Method Codes• How to find esoteric testing codes

6




Online, Free, Lab Coding Reference

Type your Query or select

from the alphabet

7

Using the Reference Lab Website

Queried “Drug Screen”

8




CODING TIP: Always Validate Testing Methods: Labs Vary

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2009 CPT Codes

83876 Myeloperoxidase (MPO)• A biomarker used in conjunction with

troponin, CK or CKMB and BNP. ID’s patients w/chest pain who are at risk for MI but have a negative troponin or ECG.

83951 Oncoprotein (DCP)• Oncoprotein biomarker intended for F/U

of patients w/chronic liver disease at risk for Hepatocellular carcinoma. (Associated w/a 4.8 increase of HCC w/in next 21 months)

10




2009 CPT Codes

85397 Coagulation & Fibrinolysis, functional activity, NOS, each analyte

• Used in Dx of thrombotic thrombocytopenic purpura & hemolytic uremic syndrome (examples of assays i.e., Disintegrin and metalloproteinase)

87905 Infectious agent enzymatic activity other than virus (e.g., sialidaseactivity in vaginal fluid)

• The test is for bacterial vaginosis with results in approx 10 minutes. Has a reported sensitivity of 90% 11

2009 CPT Changes

The old subheading following 83999“Transcutaneous Procedures” was deleted in 2009 and replaced with the new subheading “In Vivo (e.g. transcutaneous) Laboratory Procedures. The new codes are:

88720 Bilirubin, total transcutaneous88740 Hemoglobin, quantitative,

transcutaneous, per day; carboxyhemoglobin

88741 Methemoglobin12




2009 CPT Changes

Molecular diagnostics codes 83890-83909were revised in 2009. These codes represent molecular diagnostic techniques for analysis of nucleic acids.Code separately each procedure used in the analysis.Additional descriptions were added, for example, “each nucleic acid type (i.e., DNA or RNA),” “each enzyme treatment,” and “each nucleic acid preparation.”

13

HCPCS Code Selection

Select Accurate HCPCS Codes• The Blood Products

• P9010 - P9060; J2788 - J2792

• Adding on a 80000 Code to a blood product

• CAUTION: Do not unbundle or double bill

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Polling Question #1“Source of Diagnostic Information”

A diagnosis was not on the lab order. Can the lab staff accept the patient’s reason for why the test has been ordered?

[*1] Yes[*2] No

15

Official Coding Guidelines

Diagnostic Coding and Reporting Guidelines for Outpatient Services• Coding guidelines for inconclusive

diagnoses (probable, suspected, rule out, etc.) were developed for inpatient reporting and do not apply to outpatients.

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Official Coding Guidelines Diagnostic Services Only

Patients receiving diagnostic services only• For patients receiving diagnostic services

only during an encounter/visit, sequence first the diagnosis, condition, problem, or other reason for encounter/ visit shown in the medical record to be chiefly responsible for the outpatient services provided. Codes for other diagnoses may be sequenced as additional diagnoses.

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• For encounters for routine laboratory testing in the absence of signs, symptoms, or associated diagnosis, assign V72.6.

• If routine testing is performed during the same encounter as a test to evaluate a sign, symptom, or diagnosis, it is appropriate to assign both the V code and the code describing the reason for the non-routine test.

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• For outpatient encounters for diagnostic tests that have been interpreted by a physician, and the final report is available at the time of coding, code any confirmed or definitive diagnosis(es) documented in the interpretation. Do not code related signs and symptoms as additional diagnoses. Note: This differs from the coding practice in the hospital inpatient setting regarding abnormal findings on tests.

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Coding for Physician Billing Pathologist

Coding Clinic First Quarter 1990 Page: 15-16When patients receive only ancillary diagnostic services during an encounter, the appropriate V code for the examination is sequenced first. The diagnosis/problem for which the services are being performed is sequenced second.V72.6 Laboratory examination is used often by pathologists to describe the reason for the encounter (e.g. study biopsy specimen). When the bill is submitted, if there is an established diagnosis (e.g. malignant neoplasm) then an additional code can be submitted for the diagnosis. 20




Proposed New Codes for FY 2010

V72.60 Laboratory examination, unspecified

V72.61 Antibody response examination

V72.62Laboratory examination ordered as

part of a general medical examination

V72.63 Pre-procedural laboratory examination

V72.69 Other laboratory examination21

Proposed Invalid Codes for FY 2010

V72.6 Laboratory examination

22




Pathologist’s Interpretation of a Pap Smear

Scenario: Physician performed a routine gynecological examination with a pap smear. The specimen was sent to an external lab.Conclusion: The pathologist’s interpretation of the pap smear revealed abnormal cells and bacterial vaginosis.Code Assignment: V72.6 as the first listed diagnosis followed by 616.10.Rationale: Pathology claims should start with V72.6. The secondary diagnosis code represents any definitive diagnostic information. 23

Papanicolaou Test Reconfirmation V72.32

V72.32 Encounter for Papanicolaou Cervical Smear to Confirm Findings of Recent Normal Smear Following Initial Abnormal SmearThis code is assigned by the gynecologist and not the pathologist.It is routine for patients to return for several Pap tests following an initial abnormal Pap smear. 1st Pap as part of routine GYN Exam V72.31. If abnormal, 2nd pap 795.0x. When result of 2nd Pap is normal, Third pap test is V72.32, and 4th pap test is V72.32.

24




Abnormal Cytologic Smear of Anus 796.7

796.7x may be assigned as a secondary diagnosis code by the pathologist for abnormal cytologicsmear of anus and anal HPV. V72.6 is principal diagnosis for pathologist.Human papillomavirus (HPV) can occur in the anus and is associated with a higher incidence of anal cancer in HIV patients compared to the general population.Pap smears are also performed for cytologicevaluation of the anus, and similar to cervical cytology, anal cytology uses the Bethesda 2001 system to categorize the abnormalities by severity. 25

Other Codes Associated with Anal Pap Smear

V76.49 Screening for malignant neoplasm of other sites

796.77 Satisfactory anal smear but lacking transformation zone

796.78 Unsatisfactory anal cytology smear

26




Diagnosis from Ordering Physician vs. Pathologist for Pathologist ClaimScenario: A physician surgically removed a skin lesion. The specimen was sent to the pathologist to determine the nature of the lesion.Conclusion: The pathologist confirmed the lesion to be malignant. Code Assignment: The pathologist would report the appropriate malignancy code dependent on the anatomical site and the morphology of the neoplasm on his claim.Rationale: The pathologist is a physician.

27

Diagnosis for Urine Culture (Note: See Supplemental Materials for Urine Culture Flow Chart)

Scenario: A physician ordered a urinary culture for a patient experiencing sharp pelvic pains, a burning sensation in the urethra, and urine tinged with blood. The physician sent the urine sample to the lab. Conclusion: The culture was positive for a urinary tract infection (UTI).Code Assignment: The lab would report the code(s) to describe the symptoms.Rationale: The urine culture did not have physician interpretation.

28




Diagnosis for Complete Blood Count (CBC)

Scenario: A physician orders a CBC for a patient c/o frequent headaches and lethargy. The blood sample was sent to an external lab. Conclusion: The findings were low hemoglobin and hematocrit.Code Assignment: the lab would report the code(s) to describe the symptoms.Rationale: The blood sample did not have physician interpretation.

29

Diagnosis for Monitoring Effects of Long-term Use of Drugs

Assign a code from category V58.6x forpatients requiring laboratory monitoring to asses the effects of Long-term (current) drug use• Monitoring for Long-term (current) use of other

medications (i.e., chemotherapy, digitalis) V58.69 as the principal diagnosis

• Monitoring for Long-term (current) use of warfarin/Coumadin V58.61

• Monitoring for Long-term (current) use of aspirin V58.66

• Monitoring for Long-term (current) use of steroids V58.65 30




Clinical Laboratory Fee Schedule

Log on to the CMS website at: http://www.cms.hhs.gov/

• Then click “Medicare”

Scroll down, on the right hand side click “Medicare‐Fee‐for‐Service Payment”

• Then click “Clinical Laboratory Fee Schedule”

In the left hand column, click “Fee Schedule”

• Clinical Laboratory Fee Schedule – Home

31


32





33

Physician Fee Schedule




• Then click Physician Fee Schedule”

In the left hand column, click “Fee Schedule”

• Physician Fee Schedule –Home


Physician Fee ScheduleOverview

34





35

Reimbursement for OPPS Hospital Lab Tests that are Assigned APCs




• Then cllick “Hospital Outpatient PPS”

In the left hand column, click “Addendum A and Addendum B Updates”

• Addendum B April 2009

Hospital Outpatient PPS

Addendum A and Addendum B Updates

36




Reimbursement for OPPS Hospital Labs

37

Addendum B: OPPS Reimbursement

Status Indicator identifies

reimbursement method

38




Status Indicator Definitions

Click Tab and Scroll39

Billing for End Stage Renal Disease (ESRD) Related Laboratory Tests

40.6 - Medicare Publication 100- 4 Chapter 16(Rev. 1, 10-01-03) PM AB-98-7, PRM 1 2711, B3-4270.2

Hemodialysis, Intermittent Peritoneal Dialysis (IPD), and Continuous Cycling Peritoneal Dialysis (CCPD) Tests

40





With some exceptions, laboratory tests for hemodialysis, intermittent peritoneal dialysis (IPD), and continuous cycling peritoneal dialysis (CCPD) are included in the ESRD composite rate. For a particular date of service to a beneficiary, if 50 percent or more of the covered laboratory tests are noncomposite rate tests Medicare allows separate payment beyond that included in the composite rate.

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For a description of what laboratory tests and other tests are included in the composite rate and under what conditions such tests may qualify for additional payment in addition to the composite rate, see the Medicare Benefit Policy Manual Chapter 11, “End Stage Renal Disease (ESRD),” and Chapter 8 of this manual. Clinical diagnostic laboratory tests included under the composite rate payment are paid through the composite rate paid by the FI.

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Composite Rate Tests

43

Polling Question #2“The Semicolon and Modifiers”

The placement of the semicolon in the CPT description is an indication for the need of a modifier?

[*1] True [*2] False

44




National Correct Coding Initiative

The CMS National Correct Coding Initiative (NCCI) edits provide many specific instructions for use of CPT modifiers used for laboratory services. If an NCCI flag is reported on a claim, consider that modifiers may be added to remove the NCCI edit if the procedure is distinct or unrelated to other procedures performed on the same date.

45

Do these 2 Indented Codes Need a Modifier?

46





2 common methods for susceptibility

testing

47


48




Modifier -59 Distinct Procedural Service

-59 is used to identify procedures/services that are not normally reported together, but are appropriate under certain circumstances.-59 is used to designate instances when distinct and separate multiple services are provided to a patient on a single date of service.

49


-59 is only to be used if no more descriptive modifier is available-59 is used for separate sessions or patient encounters, or different procedures.-59 is used if the same procedure using the same procedure code is used for testing a different specimen (e.g. aerobic culture of two independent wound site specimens).

50





-59 is NOT used when a test is ordered and performed and additional related procedures are necessary to provide or confirm the result. These would be considered part of the ordered test.Example – A patient has an abnormal test result and repeat performance of the test is done to verify the result. Only one unit of service of the test may be reported.

51

Polling Question #3“Use of Modifier -59”

Is modifier -59 used with flow cytometry involving 88184 and 88185x 3?

[*1] Yes[*2] No

52




Modifier -91 Repeat Clinical Diagnostic Test

-91 is used to identify repeat performance of the same laboratory test on the same day to obtain subsequent (multiple) test results.For example, if a second culture was performed from the same wound site on the same day, -91 is appended.

53

Modifier -91 Repeat Clinical Diagnostic Test

-91 is NOT used when tests are re-run to confirm initial results due to testing problems when a normal, one-time reportable result is all that is required.-91 is NOT used when other CPT codes are available to describe series of results (e.g. glucose tolerance tests, evocative/suppression testing).

54




-59 or -91 Case Study

A female patient is seen in the outpatient laboratory for aerobic culture of two sites of a single wound of the left arm. The lab technologist obtains independent specimens, one from the proximal, and one from the distal wound site. 87071 is coded x 2 for quantitative aerobic bacterial culture. What modifier is appended to the second code?

55

-59 or -91 Case Study

A male patient with hypokalemia had multiple blood tests performed to check potassium following potassium replacement therapy. After the initial potassium value, three subsequent blood tests were performed on the same date following the administration of potassium to correct the patient’s hypokalemic state. 84132 x 2 is coded for serum potassium. What modifier is appended to the second code?

56




Modifier -90 Reference (Outside) Laboratory

When laboratory procedures are performed by a party other than the treating or reporting physician, the procedure may be identified by adding modifier -90 to the usual procedure number.Although the physician is reporting the performance of the test, the actual testing component was a service from a laboratory. 57

ESRD Modifiers: CD, CE, CF

Three pricing modifiers discreetly identify the different payment situations for ESRD AMCC services. The physician that orders the tests is responsible for identifying the appropriate modifier when ordering the test as follows: ● CD – AMCC test has been ordered by an ESRD

facility or MCP physician that is part of the composite rate and is not separately billable

● CE – AMCC tests has been ordered by an ESRD facility or MCP physician that is a composite rate test but is beyond the normal frequency covered under the rate and is separately reimbursable based on medical necessity 58




ESRD Modifiers: CD, CE, CF

● CF – AMCC tests has been ordered by an ESRD facility or MCP physician that is not part of the composite rate and is separately billable The ESRD clinical laboratory test identified with modifiers “CD”, “CE” or “CF” may not be billed as organ or disease panels. Upon the effective date of this business requirement, all ESRD clinical laboratory test must be billed individually.

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OIG Work Plan (FY 2009)

Compare pricing of individual tests vs. profiles Look for inappropriate unbundling of profile testsAnalyze laboratory pricing policies for End Stage Renal Disease servicesAnalyze Medicare/Medicaid laboratory services for appropriate payments

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Why Doctors Order Lab Tests?

1. To Screen for Disease2. To Diagnose a Disease/Condition3. To Monitor an existing Disease 4. To Monitor a Therapeutic Drug

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Information Available for Each “Reason”

Screening• No established diagnosis• No signs or symptoms

Diagnosing• There are signs and symptoms

Monitoring• There is a diagnosis• There is a treatment, care plan or

medication62




The Need for ABNs: Variable

To Screen for Disease• ABN not necessary unless criteria not met

To Diagnose a Disease/Condition• ABN not necessary if Signs/Symptoms given

To Monitor an existing Disease • ABN not necessary if reason for test is

provided

To Monitor a Therapeutic Drug• ABN not necessary w/V58.6x (V58.61 –

V58.69)63

Screening Tests: Legislative Provisions

See HCPCS Level II Book• Lab

• PSA G0103• PAP Smears G0123, G0143-148• Fecal Occult G0328

Blood, Immunoassay

• Radiology• Vaccines

64




Beneficiary Notices Initiative (BNI)

65

The CMSR 131

66




The CMSR 131

67

ABN Instructions and Options

68




Guidelines for Coding Blood Transfusions

Medicare Publication 100 -04• Section 250….

The OrderThe ProductThe Cross-match and other testingThe TransfusionTransfusion Reactions and Exceptions

69

Complete Billing of the Blood Transfusion

In Lab Testing The Blood Product Administration of the Product

ABO, Rh, Antibody Screen –(only 1 of each the above) When Antibody Screens are

positive multiple identification tests and procedures are required

Enter appropriate P code and # of units actually transfused

Bill 36430 once per date of service

(NOT per unit given)

Crossmatch – depending on the product ordered, bill a

crossmatch (select method) for each unit tested –

whether transfused of not

On occasion there is not a P code that completely describes the

product. Add irradiation, splitting, vol reduction as necessary.

(CAUTION: Do not double bill!

CPT code 36430 includes all supplies, nursing time, room

fees (for OP).

Revenue codes for lab may be 300 or 302. Follow FI

instructions.

Revenue Code 390 for most labs.Revenue Code 380- 38X is for purchased products or when a

hospital has its own donor center.

Revenue Code 391

70




Transfusion Medicine Case: The Facts

The patient was admitted to Short Stay unit for transfusion of 2 units of packed red blood cells. The lab had a difficult time finding compatible blood -identifying an antibody and screening 10 units of blood to find 2 units that were ultimately given. What services and units of service can be billed?

71

Transfusion Medicine Case: The Answer

ABO (86900), RH (86901), Antibody Screen (86850) 1 time for each CPT code (Rev Code 300/302)Antibody Identification (86870) or Pretreatment methods (86970- 86978) for each panel and for each technique (Rev Code 300/302)Screening for Compatible Units (86903 or 86904) for all units screened (Rev Code 300/302)Complete crossmatch (check with lab, could be 86920, 86921, and/or 86922) for each unit cross-matched (not just the ones given). (Rev Code 300/302) 72




NCCI Edits for Crossmatching

73

Transfusion Medicine Case: The Answer

PRBC (P9016 if leukoreduced or P9021 if not) for each unit given (Rev Code 390)Blood Administration (36430) 1/Day (Rev Code 391)Routine supplies are included in the blood administration APCE&M code is not used with 36430 if that is the sole service

74




Most Common “Missed” CPT Codes in Lab: Microbiology

Stool Cultures: 87045 and 87046• Most Labs use one plate for Salmonella and Shigella

which is coded with 87045

• Many Labs (esp in the South) test for multiple other pathogens which require additional plates, such as Vibrio, Yersinia, E. coli 0157, Campy, and more

Wound Cultures: 87070• Many orders for wound cultures include “Anaerobic”

and “Aerobic” initial cultures as well as gram stains

Urine Cultures: 87088• Best Practice = Every Urine culture (87088) has a

Colony Count (87086). Many labs only bill for one.75

Aerobic and Anaerobic Cultures with Blood Cultures

76




Aerobic and Anaerobic Cultures with Blood Cultures

77


Serotyping colonies (87147)• Many labs do not bill for “negative” testing• Many labs do not bill for “each” antisera used

Identification tests (87077)• Often a technologist suspects a pathogen but

the testing identifies a non-pathogen and the charge is not submitted

• When multiple isolates are tested for identification, the charge is only submitted for one ID

E tests should be billed for “each” strip (87181) 78





When doctors “add on” drugs for susceptibility testing beyond the MIC, often the Kirby Bauer test is not billed. (A modifier is required.) (87184 for KB, 87186 for MIC)Many body fluid cultures require a concentration step (i.e., centrifugation, millipore filters). Often CPT code 87015 is missed.There are numerous CCI edits for the various types of cultures. Frequently, patients (think nursing home patients or bronchial washings as an OP) have more than one culture on the same date of service. Without a modifier, only one culture will pass CCI edits. 79

For More Information on Laboratory Coding from CPT Assistant

See supplemental materials in the Appendix for further CPT Assistant citations on:

Basic metabolic panelChromosome studiesMohsOccult blood by peroxidase activityDrug Testing for opiates and barbituatesH. pylori antibody rapid qualitative test

80




For More Information on Laboratory Coding from CPT Assistant

ImmunologyIrradiation of blood productsLactoferrin, fecalReproductive medicine proceduresStrep group B detectionSurgical pathology microdissectionTransfusion medicineMicrobiology for a variety of cultures

81

Resource/Reference List

American Hospital Association (“AHA”), Coding Clinic. Chicago, Illinois • Coding Clinic, Second Quarter 2006 Page: 4

Effective with discharges: July 15, 2006 • Coding Clinic, Fourth Quarter 2008 Page: 117

to 119 Effective with discharges: October 1,2008

• CC, 1st QTR 1990 Page 22• CC, 3rd QTR 1999 Page 13-14• CC, 1st QTR 2000 Page 3, 5-6• CC, 2nd QTR 2006 Page 4

82





American Medical Association, CPT Assistant. Chicago, Illinois• CPT Assistant September 2003 Page: 5-7

• CPT Assistant, May 1997 Pages: 11-12

• CPT Assistant June 2008 Page: 157

• CPT Assistant, February 2006, Volume 16, Issue 2, pages 7-8, and page 16: Changes to Pathology and Laboratory Part I

• CPT Assistant, March 2006, Volume 16, Issue 3, pages 9 and 16: Changes to Pathology and Laboratory Part II 83


Center for Disease Control/National Center for Disease Statistics. ICD-9-CM Official Guidelines for Coding and Reporting, Effective October 1, 2008. Retrieved May 6 2009 from: http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide08.pdf

Centers for Medicare and Medicaid Services. National Correct Coding Initiative Edits. Retrieved May 6, 2009 from: http://www.cms.hhs.gov/NationalCorrectCodInitEd/U. S. Department of Health and Human Services, Office of Inspector General. Work Plan Fiscal Year 2009. Retrieved May 5, 2009 from: http://www.oig.hhs.gov/

84




Supplemental Material

CMS’ Internet Only Manuals Publication 100• Chapter 4 section 230 for Transfusion

Medicine• Chapter 8 for ESRD Guidelines• Chapter 16 for Lab Services

85

Other References: Lab Websites

http://www.questdiagnostics.com/hcp/qtim/testMenuSearch.do

http://testcatalog.mayomedicallaboratories.com/

www.labcorp.com

http://www.cms.hhs.gov/manuals/downloads/clm104c16.pdf

86




Audience Questions

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Upcoming Seminars/Webinars

Coding for Respiratory ServicesJune 18, 2009

Physician Practice E&M AuditingJuly 16, 2009

APC Revenue Cycle: Tips for SuccessJuly 23, 2009

Thank you for joining us today!Remember − sign on to the

AHIMA Audio Seminars Web site to complete your evaluation form

and receive your CE Certificate online at:

http://campus.ahima.org/audio/2009seminars.html

Each person seeking CE credit must complete the sign-in form and evaluation in order to view and

print their CE certificate

Certificates will be awarded forAHIMA Continuing Education Credit

Appendix


Resource/Reference List ....................................................................................... 48 CE Certificate Instructions

Appendix



http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/icdguide08.pdf

http://www.cms.hhs.gov/manuals/downloads/clm104c16.pdf

http://www.cms.hhs.gov/NationalCorrectCodInitEd/

www.labcorp.com

http://www.oig.hhs.gov/

http://www.questdiagnostics.com/hcp/qtim/testMenuSearch.do

http://testcatalog.mayomedicallaboratories.com/

To receive your

CE Certificate

Please go to the AHIMA Web site

http://campus.ahima.org/audio/2009seminars.html click on the link to

“Sign In and Complete Online Evaluation” listed for this seminar.

You will be automatically linked to the

CE certificate for this seminar after completing the evaluation.

Each participant expecting to receive continuing education credit must complete the online evaluation and sign-in information after the seminar, in order to view

and print the CE certificate.