2013 CPT Code changes for Molecular Pathology

This year there has been considerable code changes in every practice that has taken the healthcare industry by storm. Molecular pathology too underwent significant changes and new CPT codes. But many payers as well as CMS did not have fee schedule payments. This will be done April onwards and failing to meet the terms of the new changes can lead to delay in claim processing and claim rejection.

Some of the 2013 CPT code changes include medical lab procedures that deal with analysis of nucleic acids that detects variants in genes that indicates germline or somatic disease or tests for histocompatibility antigens. It does not include diseases causing infections or in situ hybridization analyses that are only found in Microbiology and anatomic pathology section.

Some of the deleted codes include stacking codes 83890 – 83914, 88384-88386 that are array based evaluation codes, a few genetic testing modifiers.  A new code 81479 is to be used for unlisted molecular pathology procedure. Some Tier 1 molecular pathology codes like 81200-81383 are relevant to few biomarkers. Tier 2 molecular pathology codes in the range 81400-81408 are used to refer groups of biomarkers that will need the same level of interpretive and technical resources that is necessary to finish the test.

If one is reporting a particular biomarker and not providing the complete descriptor that is there in the parenthetical CPT examples will be considered to be sufficient. But sometimes it will be important to provide the abbreviated information that will be essential to identify the service that has been provided.

For instance, The CPT code 81404 indicates “level 5” biomarker tests. CPT has identified an huge list of biomarkers that needs to be reported using code 81404. While billing for “frataxin” reporting it as FXN will be sufficient.

When a particular biomarker that has been tested is not represented by a Tier 1 code as well as not listed in Tier 2 codes, then it is best to report the test as “unlisted” using molecular pathology code 81479.  However, it needs to have a description in the narrative or remarks section when this code is used.

If descriptions are provided for Tier 2 and unlisted codes it will immensely affect in claims being processed on time and failing this will only result in claim denial or delay in processing of claim.

If you are looking for online medical coding guideline and training conferences, AudioEducator is the place where you can choose a wide range webinars that provide training on 2013 CPT code changes, OIG work plan and you can get familiar with the 2013 ICD 9 code changes and stay compliant.

Dermatology Coding Guidelines under ICD-10

With the introduction of ICD-10, that will have revised dermatology coding guidelines, dermatology billing will be more accurate and it will be easier to file clean claims. The procedure that is performed in the office determines the amount that needs to be charged by an outpatient dermatology practice. All the charges are related to specific procedure codes as complex procedures draw high reimbursement. This again is related to the practice and professional resources that are used to provide the service. The ICD-9 codes for dermatology are matched to the corresponding procedure code that implies medical necessity under the present reimbursement system.

But it has been seen for a long time that the required specificity to accurately report medical necessity lacks in ICD-9. Often, physicians assign Volume 2 codes without referring to the volume 1 codes, which usually happens to be an unspecified code, and the claim gets paid without any obstacles. But this doesn’t mean that it is a clean claim.