Joseph Yao, M.D., and Cheryl James Discuss Proprietary Laboratory Analyses (PLA) Codes
As reported in a recent article in 360Dx, more than 75 Proprietary Laboratory Analyses (PLA) codes have been issued by the American Medical Association, giving lab test manufacturers a fast-track to unique billing codes created specifically for their tests. The billing codes provide test makers a more transparent identifier for their test, and they offer the added benefit of being issued more expediently than traditional CPT codes.
"Mayo Clinic has applied for PLA codes for new clinical laboratory tests that are unique to Mayo that do not have existing specific CPT codes," said Joseph Yao, Director of Mayo Clinic's Hepatitis/HIV Laboratory and Chair of the Logical Observation Identifier Names and Codes working group, and Cheryl James, Mayo Clinic Coding and Billing Compliance Analyst. "The PLA codes will identify the testing. Otherwise, one would have to use an unlisted CPT code (such as CPT 81479: unlisted molecular pathology procedure) for coding."
Mayo Clinic, which has received nearly two dozen CPT codes, is one of the organizations that has been one of the most prolific users of the new codes. The majority of Mayo's tests have been in the areas of genetics and pharmacogenetics, according to Dr. Yao and James.
At Mayo, the shorter time frame and simpler requirements have not been the primary motivations for obtaining PLA codes; rather the institution has sought the PLA codes because there was not a specific CPT code that applied, says Dr. Yao and James.
"The shorter time frame of the PLA code review and approval process is an advantage, but this advantage should not be the main factor in determining whether a performing lab should apply for a PLA code," they said.