Laboratory Question for the Week of December 14, 2015

Laboratory Compliance Question of the Week

Question:

Can the following codes be reported together?
   87624 Infectious agent detection by nucleic acid [DNA or RNA]; human papillomavirus (HPV), high-risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)
   87625 HPV, types 16 and 18 only, includes type 45, if performed. 

Answer:

It is incorrect to report 87625 as a component of screening for a larger number of HPV types (87624) since 87624 specifies any combination of high-risk types. Therefore, it should not be broken down and billed separately for subgroups when the HPV types are tested at the same time. 

However, states CMS, there are some clinical scenarios defined by nationally accepted guidelines where identifying a particular subset of types (87625) may be medically reasonable and necessary on a patient with a positive test result for the test described by code 87624. When two separate sequential services are medically necessary, such as when a national guideline supports the use of specific type identification after a positive result on a broad assay, code 87625 may be reported separately and billed with an appropriate modifier. 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.