Pathology and Laboratory: Molecular Pathology (Q&A) (September 2018)
September 2018 page 14d
Pathology and Laboratory: Molecular Pathology
Question: The laboratory performs genetic testing for the identification of sickle cell disease. When performing full gene sequencing first and proceeding to variant duplication/deletion using a single sample, can a laboratory report both CPT codes 81364 and 81363? If so, is a modifier necessary?
Answer: It would be appropriate to report code 81364, HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); full gene sequence, with code 81363, HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); duplication/deletion variant(s), for sequencing followed by duplication/deletion analysis. Use...
Note: The following article synopsis was NOT provided by the AMA. It was created by Find-A-Code/innoviHealth.
Article Overview
This article addresses a single molecular pathology coding question from a laboratory perspective. It is aimed at coders and billing staff who work with CPT reporting for genetic testing and want to understand the article’s general guidance on sequencing and follow-on analysis performed from one sample. The piece is brief and centers on whether multiple molecular pathology codes may be reported together and whether a modifier is needed.
Why This Topic Matters
Molecular pathology claims can be sensitive to how testing is performed and reported, so even a brief clarification can affect coding consistency and claim submission accuracy.
What You Will Learn
The scope of a molecular pathology coding question involving laboratory genetic testing
How the article addresses reporting of more than one CPT molecular pathology code in a single testing workflow
Whether the article discusses modifier use in this context
The general type of guidance CPT Assistant provides for laboratory pathology reporting
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