CPT codes

Icardi, Michael michael-icardi at uiowa.edu
Tue Dec 14 12:38:56 EST 2004

I think mixing AP codes with CP codes is risky.
86359, 86360, 86064 give slightly better technical reimbursement than
88185 (so it could appear that you are upcoding), and you cannot attach
a professional code to them whether you look at them or not.  Billing
88185 without an 88184 is like billing subsequent frozen sections,
without an initial frozen section.  That will certainly send out a red
Michael S. Icardi MD.
University of Iowa Hospital
Dept. of Pathology
	-----Original Message-----From: Markestad, Sara
[mailto:SMarkestad at sjha.org] 
	Sent: Monday, December 13, 2004 11:17 AM
	To: Cytometry Mailing List
	Subject: CPT codes 
	Hello Flowers
	This is an email that I got from Code Map Compliance Briefing.
This is how we are going to bill our CPT codes for our Flow Cytometry
department. I hope that this answers all the questions that you might
	Best of luck
	Sara Markestad, MT (ASCP)
	St. Joseph's Hospital of Atlanta
	-----Original Message-----
	From: postmaster at codemap.com [mailto:postmaster at codemap.com] 
	Sent: Thursday, December 09, 2004 10:10 PM
	To: Gregg, Kris
	Subject: CodeMap Compliance Briefing 12/10/04
	CodeMap Compliance Briefing: 12/10/04 

	Editor's Welcome, 
	Many readers have responded with questions concerning the new
flow cytometry codes discussed in the November 19th CodeMap Compliance
Briefing. The examples included in that briefing left a number of issues
unresolved, so this week we present two new, more clinically relevant
examples that should answer many of your questions. The following coding
recommendations represent our best opinion at this time. However, we
expect further guidance and clarification from either the AMA and/or CMS
in the coming months concerning these new codes. Upon issuance of new
guidance we may revisit these examples to ensure our interpretation
remains accurate. Please keep the questions coming.
	Charles Root, Ph.D.
	New Flow Cytometry Codes
	The following new codes have been added to the 2005 CPT for
reporting quantitative (absolute) counts of B cells, natural killer
cells and stem cells.  
	86064	 B CELLS, total count	 
	86379	 NATURAL KILLER (NK) CELLS, total count 
	86587	 STEM CELLS (i.e., CD34), total count
	Qualitative determination (%) of cell surface cytoplasmic or
nuclear markers as well as other quantitative enumeration of cell
markers not otherwise specified in the CPT are coded using the following
new codes:
	88184	FLOW CYTOMETRY, cell surface, cytoplasmic or nuclear
marker, technical component only; first marker	    
	88185	FLOW CYTOMETRY, cell surface, cytoplasmic or nuclear
marker, technical component only; each additional marker 
	88187	FLOW CYTOMETRY, interpretation; 2 to 8 markers 
	88188	FLOW CYTOMETRY, interpretation; 9 to 15 markers 
	88189	FLOW CYTOMETRY, interpretation; 16 or more markers 
	The following examples further illustrate the use of these new
codes for both qualitative and quantitative flow cytometry panels.
	Example 1: Lymphocyte Disorder Panel (chronic lymphocytic
leukemia monitor)
	Markers determined:
	1. % CD3 (mature T-cells)
	2. % CD4 (helper/inducer cells)
	3. % CD5 (total T-cells)
	4. % CD7 (earliest T-cells)
	5. % CD8 (cytotoxic/suppressor cells)
	6. % CD10 (CALLA)
	7. % CD11c
	8. % CD19 (earliest B-cells)
	9. % CD20 (total B-cells)
	10. % CD23
	11. % CD38
	12. % CD45 (Pan leukocyte)
	13. % CD56
	14. % CD103
	15. % Kappa light chains
	16. % Lambda light chains
	Providers should use the following new codes to report the above
	88184	FLOW CYTOMETRY, cell surface, cytoplasmic or nuclear
marker, technical component only; first marker	    
	88185 X 15   FLOW CYTOMETRY, cell surface, cytoplasmic or
nuclear marker, technical component only; each additional marker
	88189	 FLOW CYTOMETRY, interpretation; 16 or more markers 
	If an independent pathologist interprets the results, he/she
would report 88189 and the laboratory would report 88184 and 88185 X15.
If no interpretation is rendered, the laboratory would report only 88184
and 88185 X 15.
	Example 2: Immune Dysfunction Evaluation Panel
	Markers determined:
	1. % and absolute CD3 (mature T-cells)
	2. % and absolute CD4 (helper/inducer cells)
	3. % and absolute CD8 (cytotoxic/suppressor cells)
	4. % and absolute dual CD3/HLA-DR
	5. % and absolute dual CD8/CD38 
	6. % and absolute dual CD8/CD28 
	7. % and absolute CD19 (B-cells)
	A pathologist interprets this panel only on request or as a
reflex for unexpected results.
	The following new and existing codes should be used to report
this panel:
	86359 T CELLS; total count
	86360 T CELLS; absolute CD4 and CD8 count, including ratio
	86064 B CELLS, total count
	88185 X 3 FLOW CYTOMETRY, cell surface, cytoplasmic or nuclear
marker, technical component only; each additional marker  
	CPT code 88185 X 3 is used to report the CD3/HLA-DR, CD8/CD38,
and CD8/CD28 counts. CPT code 88185 X 3 is used rather than 88184 plus
88185 X 2 because it is assumed that codes 86359, 86360 or 86064
represent the "initial" marker determined. Since the Medicare
reimbursement amount for 88184 is about twice the reimbursement amount
for 88185, this choice avoids any implication of "upcoding" to get a
higher Medicare reimbursement.
	If a pathologist interpretation is required and performed, the
following code would also be reported.
	88187	Flow cytometry, interpretation, 6-8 markers 
	This code represents the interpretation of 7 markers: CD3, CD4,
CD8, CD3/HLA-DR, CD8/CD38, CD8/CD28, and CD19.
	CodeMap News 

	Laboratory Providers: Ensure compliance with the complete line
of CodeMap Manuals! 
	1. The 2005 CodeMap Medicare Reimbursement Manual provides
comprehensive information concerning CPT codes, Medicare reimbursement,
and much more. It's easy-to-use and customized to your state and
	2. The 2005 CodeMap Medicare Medical Necessity Guide ensures
compliance with all Medicare coverage policies including NCDs and LCDs
(LMRPs). It contains CPT code-ICD-9 code links and frequency limitations
customized to your location. 
	3. The 2005 CCI Guide allows you to easily identify the computer
edits used by Medicare that mean the difference between a "clean" claim
and a denial.
	Order all 3 manuals to ensure your laboratory has the resources
it needs to achieve and maintain compliance.
	3 easy ways to order CodeMap Manuals:
	1. Internet: Click here
<http://www.codemap.com/2004/section.cfm?id=210>  to view sample pages
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