With the 2022 National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services now available, the Centers for Medicare & Medicaid Services (CMS) have included new guidelines related to laboratory services. Provided below are the most noteworthy additions to Chapter 10 for pathology and laboratory services (CPT codes 80000–89999). Note that “provider/supplier” or its plural forms were added to many sections of the chapter. To see smaller updates like these, please consult the NCCI manual. For clarity, each guideline is provided in its entirety with new words or sections in italic type. The identifying numbers are the same ones used by CMS in the NCCI Manual. Revisions took effect on January 1, 2022.
By contrast, some laboratory test results typically require separate follow-up testing which is implicit in the physician’s order. Such tests are termed reflex tests. For example, if an RBCantibody screen (CPT® code 86850) is positive, the laboratory proceeds to identify the RBC antibody. The reflex test is separately reportable. Similarly, if a urine culture is positive, the laboratory proceeds to organism identification testing which is separately reportable. In these examples, the initial results have limited clinical value without the separate follow-up test.
Other laboratory test results may or may not require additional testing in order to haveclinical value. This type of additional testing must be distinguished from reflex testing. The additional testing is not implicit in the initial physician order. An example is a test fora monoclonal protein band. The physician’s initial order does not implicitly include any additional testing. A laboratory shall not routinely perform additional testing to identify thetype of monoclonal protein unless ordered by the treating physician. If the patient has a knownmonoclonal gammopathy, the additional testing would not be appropriate unless ordered by thetreating physician.
If a laboratory procedure produces multiple reportable test results, only a single HCPCS/CPT code shall be reported for the procedure. If there is no HCPCS/CPT code that describes the procedure, the laboratory shall report a miscellaneous or unlisted procedure code with a single unit of service.
Proprietary Laboratory Analyses (PLA) codes are alpha-numeric codes describing manufacturers’ tests.
3. Quantitation of extracted DNA and/or RNA is included in the payment for a molecular pathology procedure (e.g., CPT codes 81161–81408). Other HCPCS/CPT codes such as CPT code 84311 (Spectrophotometry…not elsewhere specified) shall not be reported for this quantitation.
6. All genomic sequencing procedures and molecular multianalyte assays (e.g., CPT codes 81410–81471), many multianalyte assays with algorithmic analyses (e.g., CPT codes 81490–81599, 0004M-XXXXM), and many Proprietary Laboratory Analyses (PLA) (e.g., CPT codes 0001U-XXXXU) are DNA or RNA analytic methods that simultaneously assay multiple
4. CPT code 83704 (Lipoprotein, blood; quantitation of lipoprotein particle number(s) (e.g., by nuclear magnetic resonance spectroscopy) (includes lipoprotein particle subclass(es), when performed) is generally not reportedon the same date of service as CPT codes80061 (Lipid panel…), 82465 (Cholesterol…total), 84478 (triglycerides), and 83718 (Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)). Typically, a lipid panel is performed, and if necessary, the physician may order an NMR lipoprotein panel as a follow-up study to further characterize the abnormality. However, uncommonlya patient might have a previously diagnosed lipid panel abnormality and separate NMR lipoprotein panel abnormality that require retesting after a therapeutic intervention.
1. If a treating physician orders an automated complete blood count with automated differential WBC count (CPT code 85025) or without automated differential WBC count (CPT code 85027), the laboratory sometimes examines a blood smear in order to complete the ordered test based on laboratory selected criteria flagging the results for additional verification. The laboratory shall not report CPT code 85007(Blood count; blood smear, microscopic examination with manual WBC differential count) or CPT code 85008 (Blood count; blood smear, microscopic examination without manual WBC differential count) for the examination of a blood smear to complete the ordered automated complete blood count (CPT codes 85025 or 85027). The same principle applies if the treating physician orders any type of blood count and the laboratory’s practice is to perform an automated complete blood count with or without automated differential WBC count.
These are not all the NCCI changes for 2022. To explore more NCCI updates, coding, and compliance topics subscribe to our Laboratory Compliance Manager Newsletter. The Laboratory Compliance Manager Newsletter is your monthly gateway to the latest laboratory-specific compliance, coding, and reimbursement news including topics like the clinical laboratory fee schedule, coding changes, the final rules, CLIA-waived tests, and more. Subscribe today.
Today, we are continuing our January look at 2026 CPT code updates. As a reminder there were 5,933 new CPT codes with the January 1
Happy New Year! January brings resolutions, fresh starts, maybe a new diet and also newCPT codes. There were 5,933 new codes as part of the
Please log in to your account to comment on this article.
Sepsis sequencing continues to challenge even experienced coding and CDI professionals, with evolving guidelines, documentation gaps, and payer scrutiny driving denials and data inconsistencies. In this webcast, Payal Sinha, MBA, RHIA, CCDS, CDIP, CCS, CCS-P, CCDS-O, CRC, CRCR, provides clear guideline-based strategies to accurately code sepsis, severe sepsis, and septic shock, assign POA indicators, clarify the relationship between infection and organ dysfunction, and align documentation across teams. Attendees will gain practical tools to strengthen audit defensibility, improve first-pass accuracy, support appeal success, reduce denials, and ensure accurate quality reporting, empowering organizations to achieve consistent, compliant sepsis coding outcomes.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
