Coding Essentials for Laboratories 2018

Transcription

1 Coding Essentials for Laboratories 2018 An Easy-to-Use Tool for Coding and Reimbursement Compliance Prepared and Published By: MedLearn Publishing A Division of MedLearn Media, Inc. 445 Minnesota Street, Suite 514 St. Paul, MN medlearnmedia.com

2 Introduction... 1 New Way of Thinking...1 Future of Reimbursement...2 CPT Coding Guidelines...3 CPT Terminology Format...5 Coding Flowcharts...5 Quantitative vs. Qualitative...5 Specimen Codes...6 Each Specimen or Each Analyte...7 Free and Total Studies...8 Only and Screen Tests...9 Each Antigen or Each Antibody...10 Antigens or Antibodies...11 With or Without Studies...11 In Addition Studies...12 Category III CPT Codes...12 HCPCS Alternate Codes...13 Revenue Center Codes...14 Modifiers...15 National Correct Coding Initiative...19 Procedure-to-Procedure Edits...20 Add-on Edits...21 Medically Unlikely Edits...22 Other Coding Guidance...23 National Coverage Determinations...23 Local Coverage Determinations...25 Routine Screening Tests...25 Reasonable and Necessary Denials...26 Frequency Limits...26 Tests Not Ordered by Qualified Provider...26 Diagnosis Coding Guidelines for Labs...26 ICD-10 Coding System...27 Stay Informed...28 CLIA Compliance...28 Medicare Packaging of Lab Tests...28 i

3 Chapter 1: Organ and Disease Panels Standard and Custom Panels...31 Screening Tests...31 Duplicate Billing...32 ESRD Composite Rate Billing...32 Organ or Disease-Oriented Panels...33 Billing and Coding Tips...33 Coding Changes for Chapter 2: Drug Testing Drugs of Abuse Analysis...35 Presumptive Drug Analysis...36 Reporting of Presumptive Drug Analysis...36 Definitive Drug Analysis...37 Reporting of Definitive Drug Analysis...37 Opioids and Opiate Analogs...38 Billing and Coding Tips...39 Coding Changes for Chapter 3: Therapeutic Drug Assays Multiple Tests...43 Unlisted Tests...44 Billing and Coding Tips...45 Coding Changes for Chapter 4: Urinalysis Routine Urinalysis...47 Other Urinalysis...48 Coding Flowchart...49 Billing and Coding Tips...50 Coding Changes for Chapter 5: Molecular Pathology Tier 1/Tier Geonomic Sequencing Procedures and Other Molecular Analyte Assays...55 ii

4 Multianalyte Algorithmic Assay...55 Proprietary Laboratory Analyses...56 Professional Interpretation Day Rule and Date of Service...57 Payment...58 Coding Changes for Chapter 6: Chemistry Testing Custom Profiles and Panels...85 Comprehensive Codes...85 When the Specimen Matters...86 When the Method Matters...86 Frequency Limits and Overutilization...87 Example: Blood Glucose Testing...88 Billing and Coding Tips...89 Coding Changes for Chapter 7: Hematology Standardized Chargemaster for Multisite Facilities...91 Customizing Test Descriptions...91 Chargemaster-Driven Overutilization...92 Compliance Issues...92 Reflex Testing vs. Quality Assurance...92 Prescription Pad Orders...93 Coding Flowchart...95 Billing and Coding Tips...96 Coding Changes for Chapter 8: Coagulation Testing Custom Profiles and Panels...97 Medical Necessity Versus Screening...97 Standing Orders Versus Recurring Orders...97 Frequency Limits and Overutilization...98 Coding Flowchart...99 Billing and Coding Tips...99 iii

5 Coding Changes for Chapter 9: Immunology Compliance Issues Reflex Testing NCCI and Medically Unlikely Edits Authoritative Resources Billing and Coding Tips Coding Changes for Chapter 10: Microbiology Matching Order Options to the Chargemaster Submitting Follow-up Test Codes Culture of Pathogen and Detection of Infectious Agent Infectious Antigen Detection To Recap the Issues Coding Flowchart Billing and Coding Tips Coding Changes for Chapter 11: Blood Banking and Transfusion Medicine Billing for the Blood Product Crossmatch Codes Retyping the Units Code Assignment for Transfusion Medicine Services Blood Transfusions Billing and Coding Tips Coding Changes for Chapter 12: Cytopathology Non-Gynecological Specimens CPT/HCPCS Codes Intended Use of Codes Billing and Coding Tips Gynecological Specimens iv

6 CPT/HCPCS Codes Intended Use of Codes Billing and Coding Tips Coding Changes for Fine Needle Aspirate CPT/HCPCS Codes Intended Use of Codes Billing and Coding Tips Coding Changes for Flow Cytometry CPT/HCPCS Codes Billing and Coding Tips Coding Changes for Chapter 13: Cytogenetic Studies Coding Flowchart Billing and Coding Tips Coding Changes for Chapter 14: Surgical Pathology and Histology Outpatient Payment and APCs Unit of Service Date of Service Rules for Histology Specimen Processing, Special Stains and Other Related Procedures Billing and Coding Tips Frozen Section CPT/HCPCS Codes Intended Use of Codes Billing and Coding Tips Touch Prep CPT/HCPCS Codes Intended Use of Codes Billing and Coding Tips Antibody Techniques CPT/HCPCS Codes v

7 Intended Use of Codes Billing and Coding Tips Bone Marrow Studies Prostate Biopsy Mapping Specimens Morphometric Analysis CPT/HCPCS Codes Intended Use of Codes Billing and Coding Tips Nerve Teasing CPT/HCPCS Codes Intended Use of Codes Billing and Coding Tips In situ Hybridization CPT/HCPCS Codes Intended Use of Codes Billing and Coding Tips Protein Analysis of Tissue by Western Blot CPT/HCPCS Codes Intended Use of Codes Billing and Coding Tips Dissection and Microdissection Procedures CPT/HCPCS Codes Intended Use of Codes Billing and Coding Tips Postmortem Examination CPT/HCPCS Codes Intended Use of Codes Billing and Coding Tips Coding Changes for Chapter 15: In Vivo (Transcutaneous) Procedures, Miscellaneous Testing, Reproductive Medicine Handling or Shipping Fees In Vivo (Transcutaneous) Procedures vi

8 Specimen Collection (Venipunctures, Finger-sticks and Arterial Punctures) Travel Allowance Billing and Coding Tips Coding Changes for Chapter 16: Preventive Screening Procedures Prostate Antigen Screening for Adenocarcinoma Fecal Occult Blood Screening for Colorectal Cancer Measurement of Lipid Levels to Screen for Cardiovascular Disease Diabetes Screening Human Immunodeficiency Virus Sexually Transmitted Infections (STIs) Hepatitis C Virus Screening Billing and Coding Tips Chapter 17: Payment Methods for Clinical Laboratory and Professional Services Pathology Payment Methods Column 1: HCPCS Column 2: Mod (Modifier) Column 3: MPFS Status Code Column 4: MPFS PC/TC Indicator Column 5: MPFS Work RVU Column 6: MPFS Facility RVU Column 7: Non-Facility RVU Column 8: MPFS Conversion Factor Column 9: OPPS Status Indicator Column 10: OPPS APC Rate Column 11: CLFS 2018 Payment Clinical Pathology Consultations Consultations on Referred Material Appendix A: Medicare Manuals vii

9 Appendix B: Medicare Quality Payment Programs MACRA MIPS Advanced APMs Tips for Quality Compliance viii