Tuesday, August 4, 2015

Procedure code 87507, 87623,87624,87625, 87806, 89337, G0464 - LAB CODE NEW UPDATE


Code 87507 (Infectious agent detection by nucleic acid (DNA or RNA); 
gastrointestinal pathogen (eg, Clostridium difficile, E. coli, Salmonella, Shigella, norovirus, Giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets).

Industry Recommendation:Crosswalk to Code 87633 (Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), multiplex reversetranscription and amplified probe technique, multiple types or subtypes, 12-25 targets)

CMS Recommendation: Crosswalk to Code 87633.

Rationale: CMS agrees with the commenters recommending the crosswalk to Code 87633,based on similarities in function.

Code 87623 (Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44)).
Industry Recommendation: Crosswalk to Code 87621 (Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human, amplified probe technique).

CMS Recommendation: Crosswalk to Code 87621.

Rationale: CMS agrees with the commenters recommending the crosswalk to Code 87621, based on similarities in function.

Code 87624 (Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)).



87624 - Hpv high-risk types

Industry Recommendation: Crosswalk to Code 87621 (Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human, amplified probe technique).

CMS Recommendation: Crosswalk to Code 87621.

Rationale: CMS agrees with the commenters recommending the crosswalk to Code 87621, based on similarities in function.



Code 87625 (Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed).
Industry Recommendation: Crosswalk to Code 87621 (Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human, amplified probe technique).

CMS Recommendation: Crosswalk to Code 87621.

Rationale: CMS agrees with the commenters recommending the crosswalk to Code 87621,based on similarities in function

Human Papilloma Virus (HPV)

CPT 2015 has redone HPV coding by deleting 87620-87622 and adding three new codes 87623-87625. The new codes have been added to differentiate high and low risk HPV types. This HPV genotyping should be used in conjunction with or as a follow-up to an abnormal cytology report.


Low -risk types would be reported with code 87623 and high-risk types with code 87624. 


Code 87625 is reported only for HPV types 16 and 18 and includes type 45, if performed. If both low-risk and high-risk HPV types are performed in a single assay, only code 87624 for high- risk genotyping should be reported per the parenthetical note following code 87624.

Human Papillomavirus (HPV) Laboratory Testing Codes 87623, 87624 and 87625

Effective on claims with dates of service on or after January 1, 2015, the following CPT codes can be used for Human Papillomavirus (HPV) Laboratory Testing: 87623, 87624 and 87625. The three codes replace CPT code 87621, which can no longer be billed effective on claims with dates of service on or after December 31, 2014. 


Affected provider types are 12, 17 (specialties 174, 183, 195, 196, 197, 198), 20, 21, 24, 43, 72, 74 and 77. Claims submitted by the above listed provider types for CPT codes 87623, 87624 and 87625 with dates of service on or after January 1, 2015, through July 24, 2015, that denied will be automatically reprocessed. The results of the reprocessed claims will appear on a future remittance advice. 

Code 87806 (Infectious agent antigen detection by immunoassay with direct optical observation;HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies).

Industry Recommendations: Crosswalk to Code 87390 (Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-1) PLUS Code 86703 (Antibody; HIV-1 and HIV-2, single result); OR Crosswalk to Code 87389 (Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result).

CMS Recommendation: Crosswalk to code 87389.

Rationale: CMS agrees with the commenters recommending the crosswalk to Code 87389, based on similarities in function. CMS disagrees with the commenters recommending the crosswalk to both Code 87390 and Code 86703 because those two codes together do much more in comparison to the new Code 87806. Therefore, the one-to-one crosswalk to Code 87389 is more accurate.

Code 89337 (Cryopreservation, mature oocyte(s)).

Industry Recommendation: Crosswalk to Code 89258 (This code is not on the CLFS).

CMS Recommendation: This test should not be priced on the CLFS.

Rationale: This test code represents embryo storage; therefore, it is not a clinical diagnostic laboratory test

Code G0464 (Colorectal cancer screening; stool-based DNA and fecal occult hemoglobin (e.g., KRAS, NDRG4 and BMP3)).

Industry Recommendation: Crosswalk to Code 81315 (PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic leukemia) translocation analysis; common breakpoints (eg, intron 3 and intron 6), qualitative or quantitative) PLUS Code 81275 (Kras (v-Ki-ras2 Kirsten rat sarcoma viral oncogene) (eg, carcinoma) gene analysis, variants in codons 12 and 13) PLUS Code 82274 (Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations).

CMS Recommendation: Crosswalk to Code 81315 PLUS Code 81275 PLUS Code 82274.

Rationale: CMS agrees with the commenters recommending the crosswalk to Code 81315 PLUS Code 81275 PLUS Code 82274, based on similarities in function of these tests with the components of the new test.




Clarification for Coding Relating to Cologuard

The Centers for Medicare & Medicaid Services (CMS) recently implemented a National Coverage Determination to cover Cologuard – a multitarget stool DNA test – as a colorectal cancer screening test for asymptomatic, average risk beneficiaries, aged 50 to 85 years.

Previously, providers/suppliers used Healthcare Common Procedure Coding System (HCPCS) code G0464 to bill for the Cologuard test.

Per the 2016 Clinical Lab Fee Schedule CR 9465, effective December 31, 2015, HCPCS code G0464 expires.

Beginning January 1, 2016, providers/suppliers should bill CPT code 81528 for the Cologuard test. Continue to use HCPCS code G0464 for claims with prior dates of service through December 31, 2015.



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