2009 CPT/HCPCS Updates: Implementation September 1, 2009

Pathology

All new CPT-4 and HCPCS laboratory codes, unless otherwise specified, have the following diagnosis excludes: V70, V70.0, V70.5, V70.6, V70.7, V70.8, V70.9, V72, V72.1, V72.6 and V72.9.

HCPCS codes G0416 – G0419 (surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling) are Medi-Cal benefits and may not be billed together during the same session nor with CPT-4 codes 88300 – 88309.

Codes G0416 – G0419 are split-billable and must be billed with appropriate modifier 26, 99, TC or ZS.

Billing Restrictions

The following codes are not split-billable and must not be billed with modifiers 26, 99, TC or ZS: S3860, S3862, 83876, 83951, 85397, 87905, 88720, 88740 and 88741.

HCPCS codes S3860 and S3862 (genetic testing) require a TAR and are once-in-a-lifetime tests.

HCPCS code S3862 (genetic testing, family-specific ion channel analysis) requires a TAR that must include the following documentation:

• The family member being tested is a Medi-Cal recipient, and
• There is clinical documentation of at least one first-degree relative (parent, sibling or offspring) with a laboratory-confirmed LQTS genetic mutation

CPT-4 code 83876 (myeloperoxidase [MPO]) is a Medi-Cal benefit for patients with ischemic heart disease and must be billed with a diagnosis in the range of ICD-9-CM codes 410 – 414.9.

CPT-4 code 83925 (opiates[s], drug and metabolites, each procedure) requires documentation that a prior drug screen was positive for opiates.

CPT-4 code 83951 (oncoprotein; des-gamma-carboxy-prothrombin [DCP]) must be billed with an ICD-9-CM diagnosis within one of the ranges below:

ICD-9-CM Code Description

• 070.20 – 070.9 Viral hepatitis
• 150.00 – 155.2 Malignant neoplasm of esophagus, stomach, small intestine, colon, rectum or liver
• 570.00 – 571.9 Acute and subacute necrosis of liver or chronic liver disease and cirrhosis

CPT-4 code 87905 (infectious agent enzymatic activity other than virus) is a CLIA and is billed with modifier QW.

Deleted and Replacement Code

The policy of the deleted code applies to the replacement.

• Deleted Code: 88400
• Replacement Code: 88720