Incorrect Billing of Certain Molecular Biomarker Codes for Jun. 2017

National Government Services has seen an increase in claims incorrectly coded with individual codes for molecular biomarkers when five or more gene tests are completed for lung cancer, using next generation sequencing methodology. Correct coding requires that when a panel code applies it should be billed rather than the individual test codes. Thus, CPT code 81445 should be billed when five or more gene tests for molecular biomarkers for lung cancer are completed. If fewer than five, but more than two genes are billed, then the unlisted code 81479 should be billed.

INDUSTRY NEWS TAGS: National Government Services, MAC J6 Wisconsin, MAC J6 Illinois, MAC J6 Minnesota, MAC JK Maine, MAC JK Massachusetts, MAC JK New Hampshire, MAC JK Rhode Island, MAC JK Vermont, MAC JK Connecticut, MAC JK New York

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