Andrea:
Actually 86360 is not so new, it has actually been around since 1996. You should always use the code that most accurately describes the test that you are performing. I am assuming you are referring to HIV monitoring when you refer to CD4/8 w/ratio testing (the rules are different if you are referring to Leuk/Lymph Immunophenotyping). Some people were using both 88180 and 86360 thinking that the 86360 was being reimbursed for the absolute count part of it. This is actually double dipping and the government won't look too kindly on you for doing that. You can't charge for a calculation, which is what you would be charging for if you used both CPT codes. Since absolute count is considered the "medical necessary" test result, it is most appropriate to use the 86360. If you are also requested to report the Total CD3 count in addition to the 4/8 then you can also include 86359 for Total T cells. Keep in mind, however, if it wasn't ordered this way you can't add it on your own. We would use 88180 for any marker used in a Leukemia/Lymphoma Panel, even if it was a CD4/CD8 combination since we don't report absolute numbers in this case. These decisions were based on our consultations with Ernst & Young, our consultants for billing coding, however, it is always wise to consult your institution's gurus in these areas as there can be mighty stiff fines if you make the wrong choices.
My 2 cents-
Joanne Thomas, M.S.
Director of Operations
TRITECH Field Engineering
2014 Renard Court, Suite I
Annapolis, MD 21401
1-800-886-7004 (USA)
1-410-266-1522
410-266-0935 (FAX)
thomas@tritechinc.com
-----Original Message-----
From: Andrea Illingworth <dcdsflow@mint.net>
To: Cytometry Mailing List <cytometry@flowcyt.cyto.purdue.edu>
Date: Thursday, May 11, 2000 5:20 PM
Subject: CPT code for CD4/CD8
We just found out about the new code 86360 for the absolute number for CD4 and CD8 cells and CD4/CD8 ratio. We have been using the 88180 code and are unsure if the new code is to be used or if it is to be used for the CD4/CD8 test done by other methods than flow cytometry.
Any insight from the regulatory experts?
Thank you - Andrea
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