Laboratory Question for the Week of January 4, 2016

Laboratory Compliance Question of the Week


Our laboratory frequently bills for each species of Candida reported even when the detection is determined during a single procedure. Is this correct coding? 


The January 1, 2016 update to the National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services clarifies that the CPT code that is pleural in nature is intended to capture all species reported from a single procedure. Only if separate procedures are performed are multiple units of service billable. 

According to the new guideline, infectious agents may be identified by antigen detection (e.g., CPT codes 87301–87450), immunofluorescence microscopy (e.g., CPT codes 87260–87299), or nucleic acid probe (e.g., CPT codes 87470–87501, 87510–87592, 87640–87799) techniques. If a single test procedure produces results for multiple species or strains of an organism, only one unit of service (UOS) of a CPT code may be reported for that test procedure. 

However, if separate medically reasonable and necessary test procedures are performed for different species or strains of an organism, the same CPT code may be reported for each test procedure utilizing modifier 59 for the second and additional test procedures. 

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.