Complete This Scavenger Hunt to Rule Path/Lab in 2018

looking for 2018 lab coding changes

Every medical specialty has its coding nuances, but pathology and lab coding has to rank near the top when it comes to specialized rules. And just when you thought you’d mastered them all, 2018 came along to add more for you to learn. Ready to test your skills? Below you’ll find a scavenger hunt of sorts with questions and a link to the blog where you’ll find the answer. What’s the prize if you finish? Knowing you’re awesome! Plus cleaner claims, which is a pretty good reward.

Ready, Set, Go!

1. Find the three-letter abbreviation used when talking about duplicate lab codes that vary based only on the proprietary name listed in a CPT® appendix. The 2018 CPT® code set includes a new symbol to identify these codes.

Related blog post (hint: answer is near the end): Can’t-Miss Corrections to CPT® 2018 Available Now!


2. Fill in the blanks: The changes to the CLFS in 2018 are due to the Protecting Access to Medicare Act (PAMA) including a goal to use the ________ ______ of private payer rates for lab tests.

Related blog post: Did You Catch It? New Year, New Look for CLFS (and for you go-getters who subscribe to Pathology/Lab Coding Alert, there are some helpful articles here and here).


3. The 2017 Medicare Fee-for-Service Supplemental Improper Payment Data report based on Comprehensive Error Rate Testing (CERT) put lab tests in the top spot for highest projected improper payments by dollar value. Find the dollar amount.

Related blog post (and, no, the answer is not $36.2 billion): $36.2 Billion in Improper Payments Means CMS Will Watch These Areas


4. The CPT® 2018 code set added new codes for hemoglobin, subunit beta. They list the clinical examples of sickle cell anemia, beta thalassemia, and hemoglobinopathy. As part of this update, HBB was removed from the descriptors of three codes. Find them.

Related blog post: Preview What’s New for Path/Lab in CPT® 2018


5. For bonus points, you have to hunt outside of the blog. CMS has posted the list of tests granted waived status under CLIA effective April 1, 2018. The new tests require modifier QW. Find two codes that you do not need to use modifier QW on for CMS to recognize them as waived tests.

Where to find it: Page 2 of Transmittal 3945, CR 10418

Answers (In Case Scavenger Hunts Aren’t Your Thing)

  1. PLA (proprietary lab analyses)
  2. Weighted median
  3. $1,121,237,359 (Tip: The providers who order tests from you may find guides like this one on blood counts useful for improving compliance with Medicare rules.)
  4. Level 2, 4, and 5 codes 81401, 81403, and 81404 (I can’t be the only one who wishes the level matched the last digit in the code. Right?)
  5. Choose any two from 81002, 81025, 82270, 82272, 82962, 83026, 84830, 85013, and 85651. Using QW shows the test (based on name and manufacturer) you’re reporting has been granted waived status under CLIA. When all tests that fall under a code are CLIA-waived, regardless of manufacturer, you do not need to append QW. You still need a CLIA certificate of waiver, though.

How About You?

How did you do? What’s your favorite oddity in the specialty you code for?


Deborah works on a wide range of TCI SuperCoder projects, researching and writing about coding, as well as assisting with data updates and tool development for our online coding solutions. Since joining TCI in 2004, she’s covered the ins and outs of coding for radiology, cardiology, oncology and hematology, orthopedics, audiology, and more.

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