CCI 18.0: 87389: Choose Just 1 HIV Test Code or Face Denials

Update bundles meant for cytology, special stains.

Just as you're beginning to use CPT® 2012 changes in your laboratory, the latest edition of Medicare's Correct Coding Initiative (CCI) limits how you can use some of those CPT codes.

Remember: You cannot just go ahead and add a modifier (such as 59, Distinct procedural service) any time you wish to separate a code bundle, you'd have to validate it with the physician's documentation that denotes the distinct nature of the service, like a separate site or session.

87389 Stands Alone

With ample of HIV lab tests available, only one CPT code explains a single-result test for antigens and antibodies. That code was added in CPT 2012: 87389 (HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result).

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On the other hand, other HIV CPT codes describe a test for one or the other -- HIV antibodies or HIV antigens. Other HIV-1 and HIV-2 antigen and antibody test CPT codes are as follows:

Antibody tests:

86701 – (Antibody; HIV-1)

86702 – ( HIV-2)

86703 – ( HIV-1 and HIV-2 single result)

Antigen tests:

87390 – (Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-1)

87391 – ( HIV-2)

87534 – (Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe technique)

87535 – ( HIV-1, amplified probe technique)

87536 – ( HIV-1, quantification)

87357 – ( HIV-2, direct probe technique)

87358 – (HIV-2, amplified probe technique)

87359 – ( HIV-2, quantification)

CMS bundles some of these tests with CPT code 87389 in the latest CCI update. Specially, new edit pairs restrict billing 87389 with the combined HIV-1/HIV-2 antibody test (86703) and HIV-1 antigen tests 87535, 87536 and 87390. The "0" modifier indicator for most of these code bundles means that you should not override the edit pair under any circumstance.

Here's why: Because 87389 indicates both the HIV-1 antigen status and the HIV-1/HIV-2 antibody status of the patient, additionally reporting individual tests for the same indicators would be inappropriate.

More: CCI Edit 18.0 also bundles CPT code 87389 with some services that might be part of the prep steps for that assay: 87147 (Culture, typing; immunologic method, other than immunofluoresence [e.g., agglutination grouping], per antiserum) and 87253 (Virus isolation; tissue culture, additional studies or definitive identification [e.g., hemabsorption, neutralization, immunofluoresence stain], each isolate). These bundles include a modifier indicator of "1," implying that you can override the edit pair, when suitable.

In case the virus isolation or culture typing is not part of 87389, however you carry it out for a different test on the similar day as the combined HIV test, you can then use modifier 59 to override the edit pair.