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Pathology and Laboratory 2014 CPT Code Changes

Alert Details

The 2014 CPT code changes became effective January 1, 2014. There are several updates that impact pathology and laboratory providers. The following is a brief overview of these updates. Full lists of CPT details can be found at www.sva.com under Healthcare Medical Coding and Billing Resources.

Therapeutic Drug Assays

10 new codes have been added to this section to identify therapeutic drug assays. The material for examination may be from any source, and are quantitative in nature. For nonquantitative testing, see Drug Testing (80100-80104).

  • 80155 – Caffeine
  • 80159 – Clozapine
  • 80169 – Everolimus
  • 80171 – Gabapentin
  • 80175 – Lamotrigine
  • 80177 – Levetiracetam
  • 80180 – Mycophenolate (mycophenolic acid)
  • 80183 – Oxcarbazepine
  • 80199 – Tiagabine
  • 80203 – Zonisamide

Molecular Pathology Procedures

A new Molecular Pathology Table has been added to identify the genes associated with the CPT codes. Multiple changes have occurred for reporting the Tier 1 and Tier 2 MoPath codes.

  • Tier 1: Now contains 107 codes, including:
    • 1 code that was added in May of 2012 but did not appear in the 2013 CPT book for DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) deletion analysis (81161)
    • 1 new code for reporting MGMT methylation analysis (81287)
    • 3 codes with revised CPT code descriptions for HLA typing (81371, 81376, 81382)
  • Tier 2: Multiple revisions to the codes in this section (81400-81408)
    • 318 new analytes have been added
    • See CPT Appendix B for a complete listing of the new, revised, and deleted analytes

Multianalyte Assays with Algorithmic Analyses

2 new MAAA codes have been added including:

  • 1 new code for oncology microarray gene expression profiling (81504)
  • 1 new code that uses cell free fetal DNA to screen for fetal aneuploidy (81507)
  • See CPT Appendix O for a table of MAAAs including:
    • 1 new administrative code (0004M)
    • 1 converted code (0005M to 81507)

Chemistry

Code 84112 for evaluation of cervicovaginal fluid has been revised to include other proteins that are also tested in amniotic fluid.

Microbiology

1 new code has been added and 7 CPT code descriptions have been revised including:

  • new code added to describe a test used to detect Trichomonas vaginalis by amplified probe technique (87661)
  • 7 codes for RNA assays were revised to indicate that reverse transcription is included when performed (87498, 87521, 87522, 87535, 87536, 87538, 87539)

Surgical Pathology

CMS Medicare has revised the HCPCS “G” code (G0416-G0419) descriptors to indicate “any method” for 10 or more prostate biopsy specimens.

For Governmental Payers (Medicare/Medicaid)

  • The G codes are to be used for all prostate biopsy specimens of 10 or more regardless of the method used to obtain the specimens
  • Codes G0416-G0419 are chosen based on the number of specimens obtained:
    • 10-20 specimens: G0416
    • 21-40 specimens: G0417
    • 41-60 specimens: G0418
    • >60 specimens: G0419
  • Providers will continue to use CPT 88305 Level IV surgical pathology, gross and microscopic examination for prostate biopsy specimens of 9 or less
  • The number of units will be based on the number of separately identifiable specimens submitted and separately documented

For Commercial Payers

  • Providers will not report the “G” codes, but will continue to use CPT 88305 to report each separately identifiable prostate biopsy specimen submitted and separately documented

Immunohistochemistry/ Immunocytochemistry (IHC)

There are new and revised codes for reporting immunohistochemistry (IHC) stains:

  • Immunohistochemistry (IHC) code 88342 has been revised to more clearly define the unit of service
    • Prior to 2014, 88342 described immunohistochemistry including tissue immunoperodixase, each antibody
    • In 2014, the code descriptor now includes immunocytochemistry and describes each separately identifiable antibody per block, cytologic preparation, or hematologic smear
    • The unit of service is the first separately identifiable antibody per slide
  • An add-on code (+88343) has been created to identify each additional separately identifiable antibody per slide
    • When more than one antibody is applied to the same slide, one unit of 88342 should be reported with one unit of 88343 for each additional antibody
  • Two new HCPCS codes (G0461 and G0462) were also created to report immunohistochemistry (IHC) procedures to governmental payers (Medicare/Medicaid) in lieu of CPT codes 88342 and 88343

Why are there two sets of codes for reporting immunohistochemistry?

Current coding requirements only allowed CPT 88342 to be billed once per specimen for each antibody. According to the AMA, the revision to 88342 and the new add-on code was created to clear up confusion regarding the unit of service.

  • However, CMS disagreed with the AMA’s descriptors for 88342 and 88243 in the Physician Fee Schedule Final Rule which allows for coding based on block, instead of per specimen
  • CMS believes the new code descriptors for 88342 and 88343 would allow the reporting of multiple units for each slide and each block per antibody which would encourage overutilization
  • Therefore, CMS created 2 new HCPCS codes (G0461 and G0462) to ensure that the services are only reported once for each antibody per specimen
    • G0461 to report one unit of service per specimen
    • G0462 to report each additional stain

For Governmental Payers (Medicare/Medicaid)

  • For governmental payers, coders should assign G0461 and G0462 for IHC stains based on the separately identifiable specimens per different antibody
    • It is not based on the block or slide
  • CMS does not recognize codes 88342 or 88343 for reporting IHC stains
  • G0461 is reported for the first IHC antibody tested on the specimen
  • G0462 is reported for any additional antibody that is performed and documented on that same specimen

For Commercial Payers

  • For commercial payers, coders should assign 88342 per separate specimen, per block that is performed on a separate slide for each different antibody performed
  • Code 88343 would be assigned when any additional separate antibodies are performed on the same slide

Resource: AMA – CPT 2014 Changes – An Insider’s View


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