Editor’s note: This is the conclusion of a two-part article. In the first part, which appeared in the April issue, we discussed the quality standards that are required to perform labs in the physician office. As we venture into another area, we will attempt to cover the basic steps that will assist in office compliance, as well as efficient coding and reimbursement.
Laboratory coding has nuances, but is under the same AMA guidelines of proper coding as all other clinical areas. The rheumatologist and other nonphysician providers in rheumatology practices must be certain that the correct code is applied to ensure accurate diagnosing of patients and proper reimbursement. Laboratory tests are an important tool in treating patients with autoimmune disorders.
In the world of labs, there is a great quantity of labs available for providers to utilize in treating and managing patients with autoimmune disorders. The most common lab tests used day to day in rheumatology practices are C-reactive protein, sedimentation rate, rheumatoid factor, complete blood count, urinalysis, comprehensive metabolic panel, antinuclear and uric acid. Any of these can be ordered individually or in combination, as determined by the health professional. A complete guide to ensure proper coding and billing follows.
Not only are these codes for manual and automated performances of complete blood counts, there are also codes for each component. Nurse practitioners and physician assistants should refer to the index in the AMA CPT manual for the appropriate list of codes. For most single or small group offices, the codes for hematocrit or blood count other than spun (CPT 85014), colormetric hemoglobin (CPT 85018), manual cell count (CPT 85032) and automated hemogram (CPT 85025–85027) may be the ones most frequently applied. It’s recommended that your billing form list those tests that regularly apply to your practice.
Urinalyses (CPT 81000–81020) can be listed as a complete routine (with pH, specific gravity, protein, reducing substance and microscopy) or by constituent subsets (complete microscopy) or qualitative chemical analysis with any number of constituents.
Body fluids cultures may be described using CPT codes 87040–87999, depending on the site or origin and the type of culture obtained. Urine cultures are usually performed in a quantitative manner with colony counts. Use CPT 87088 if the test was performed with a commercial kit for organism identification in addition to the culture codes themselves, and use CPT 87086 if the rest was performed by another method.
Organ or Disease Oriented Panel
Lab panels have undergone significant changes in the past few years, and they remain a source of confusion. There is no longer a list of automated multichannel tests. Tests should be reported individually unless they compose one of the nine organ- or disease-oriented panels.