I think mixing AP codes with CP codes is risky. 86359, 86360, 86064 give slightly better technical reimbursement than 88185 (so it could appear that you are upcoding), and you cannot attach a professional code to them whether you look at them or not. Billing 88185 without an 88184 is like billing subsequent frozen sections, without an initial frozen section. That will certainly send out a red flag. Michael S. Icardi MD. University of Iowa Hospital Dept. of Pathology -----Original Message-----From: Markestad, Sara [mailto:SMarkestad@sjha.org] Sent: Monday, December 13, 2004 11:17 AM To: Cytometry Mailing List Subject: CPT codes Hello Flowers This is an email that I got from Code Map Compliance Briefing. This is how we are going to bill our CPT codes for our Flow Cytometry department. I hope that this answers all the questions that you might have. Best of luck Sara Markestad, MT (ASCP) St. Joseph's Hospital of Atlanta 404-851-7744 -----Original Message----- From: postmaster@codemap.com [mailto:postmaster@codemap.com] Sent: Thursday, December 09, 2004 10:10 PM To: Gregg, Kris Subject: CodeMap Compliance Briefing 12/10/04 <http://www.codemap.com> www.codemap.com CodeMap Compliance Briefing: 12/10/04 _____ Editor's Welcome, Many readers have responded with questions concerning the new flow cytometry codes discussed in the November 19th CodeMap Compliance Briefing. The examples included in that briefing left a number of issues unresolved, so this week we present two new, more clinically relevant examples that should answer many of your questions. The following coding recommendations represent our best opinion at this time. However, we expect further guidance and clarification from either the AMA and/or CMS in the coming months concerning these new codes. Upon issuance of new guidance we may revisit these examples to ensure our interpretation remains accurate. Please keep the questions coming. Sincerely, Charles Root, Ph.D. New Flow Cytometry Codes The following new codes have been added to the 2005 CPT for reporting quantitative (absolute) counts of B cells, natural killer cells and stem cells. 86064 B CELLS, total count 86379 NATURAL KILLER (NK) CELLS, total count 86587 STEM CELLS (i.e., CD34), total count Qualitative determination (%) of cell surface cytoplasmic or nuclear markers as well as other quantitative enumeration of cell markers not otherwise specified in the CPT are coded using the following new codes: 88184 FLOW CYTOMETRY, cell surface, cytoplasmic or nuclear marker, technical component only; first marker 88185 FLOW CYTOMETRY, cell surface, cytoplasmic or nuclear marker, technical component only; each additional marker 88187 FLOW CYTOMETRY, interpretation; 2 to 8 markers 88188 FLOW CYTOMETRY, interpretation; 9 to 15 markers 88189 FLOW CYTOMETRY, interpretation; 16 or more markers The following examples further illustrate the use of these new codes for both qualitative and quantitative flow cytometry panels. Example 1: Lymphocyte Disorder Panel (chronic lymphocytic leukemia monitor) Markers determined: 1. % CD3 (mature T-cells) 2. % CD4 (helper/inducer cells) 3. % CD5 (total T-cells) 4. % CD7 (earliest T-cells) 5. % CD8 (cytotoxic/suppressor cells) 6. % CD10 (CALLA) 7. % CD11c 8. % CD19 (earliest B-cells) 9. % CD20 (total B-cells) 10. % CD23 11. % CD38 12. % CD45 (Pan leukocyte) 13. % CD56 14. % CD103 15. % Kappa light chains 16. % Lambda light chains Providers should use the following new codes to report the above panel: 88184 FLOW CYTOMETRY, cell surface, cytoplasmic or nuclear marker, technical component only; first marker 88185 X 15 FLOW CYTOMETRY, cell surface, cytoplasmic or nuclear marker, technical component only; each additional marker 88189 FLOW CYTOMETRY, interpretation; 16 or more markers If an independent pathologist interprets the results, he/she would report 88189 and the laboratory would report 88184 and 88185 X15. If no interpretation is rendered, the laboratory would report only 88184 and 88185 X 15. Example 2: Immune Dysfunction Evaluation Panel Markers determined: 1. % and absolute CD3 (mature T-cells) 2. % and absolute CD4 (helper/inducer cells) 3. % and absolute CD8 (cytotoxic/suppressor cells) 4. % and absolute dual CD3/HLA-DR 5. % and absolute dual CD8/CD38 6. % and absolute dual CD8/CD28 7. % and absolute CD19 (B-cells) A pathologist interprets this panel only on request or as a reflex for unexpected results. The following new and existing codes should be used to report this panel: 86359 T CELLS; total count 86360 T CELLS; absolute CD4 and CD8 count, including ratio 86064 B CELLS, total count 88185 X 3 FLOW CYTOMETRY, cell surface, cytoplasmic or nuclear marker, technical component only; each additional marker CPT code 88185 X 3 is used to report the CD3/HLA-DR, CD8/CD38, and CD8/CD28 counts. CPT code 88185 X 3 is used rather than 88184 plus 88185 X 2 because it is assumed that codes 86359, 86360 or 86064 represent the "initial" marker determined. Since the Medicare reimbursement amount for 88184 is about twice the reimbursement amount for 88185, this choice avoids any implication of "upcoding" to get a higher Medicare reimbursement. If a pathologist interpretation is required and performed, the following code would also be reported. 88187 Flow cytometry, interpretation, 6-8 markers This code represents the interpretation of 7 markers: CD3, CD4, CD8, CD3/HLA-DR, CD8/CD38, CD8/CD28, and CD19. CodeMap News _____ Laboratory Providers: Ensure compliance with the complete line of CodeMap Manuals! 1. The 2005 CodeMap Medicare Reimbursement Manual provides comprehensive information concerning CPT codes, Medicare reimbursement, and much more. It's easy-to-use and customized to your state and locality. 2. The 2005 CodeMap Medicare Medical Necessity Guide ensures compliance with all Medicare coverage policies including NCDs and LCDs (LMRPs). It contains CPT code-ICD-9 code links and frequency limitations customized to your location. 3. The 2005 CCI Guide allows you to easily identify the computer edits used by Medicare that mean the difference between a "clean" claim and a denial. Order all 3 manuals to ensure your laboratory has the resources it needs to achieve and maintain compliance. 3 easy ways to order CodeMap Manuals: 1. Internet: Click here <http://www.codemap.com/2004/section.cfm?id=210> to view sample pages and order your 2005 CodeMap Manual from our website; 2. Phone: Call us at 800-522-3285 to place your order. We accept credit cards and purchase orders; 3. Fax: Click here <http://www.codemap.com/2004/fax_form.cfm> to download an order form. Then fill it out and fax it to us at (847) 381-4606. 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If you are neither the intended recipient nor the employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any disclosure, copying, distribution or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received this communication in error, please notify us immediately by replying to the message and deleting it from your computer. Thank you. Saint Joseph's Health System, Inc.Received on Wed Dec 15 15:58:00 2004
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