Chapter_025.pptx

CHAPTER 25

PATHOLOGY / LABORATORY

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Types of Pathology and Laboratory

Subsections such as:

Organ or Disease-Oriented Panels

Drug Assay

Therapeutic Drug Assays

Evocative/Suppression Testing

Consultations (Clinical Pathology)

Urinalysis

Molecular Pathology

Chemistry

Hematology and Coagulation

Immunology

Transfusion Medicine

Microbiology

Anatomic Pathology

Cytopathology

Cytogenetic Studies

Surgical Pathology

Transcutaneous Procedures

Other Procedures

Reproductive Medicine Procedures

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The Pathology and Laboratory section of the CPT manual is formatted according to types of tests performed.

Pathology and Laboratory

Codes for laboratory test only

Specimen collectioncoded separately

Example: Venous blood draw reported 36415 (Surgery section)

Medicare fee schedule each year identifies those lab tests associated with a physician component (modifier -26)

From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders.

Figure 25.1

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The services in the Pathology and Laboratory section include the laboratory tests only.

The collection of the specimen is coded separately from the analysis of the test.

Per the example: If a patient had a clinic lab technician withdraw blood by means of a venipuncture of the finger and the sample was analyzed in the lab:

Use code 36415 for venipuncture, in addition to a code to report the test performed on the blood.

Use G0001 for Medicare patients.

Facility Indicators

Allow additional tests without physician written order

Example:

Urinalysis positive for bacteria

Built-in indicator for culture

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Laboratories have built-in indicators that allow additional tests to be performed without a written order from the physician.

These standards are set by the medical facility.

Indicators imply that if a test is found positive, it is assumed that the physician wants more information on the condition.

If a routine urinalysis is performed, a culture is performed if the test is positive for bacteria.

Pathology/Laboratory Caution

Usually report second or subsequent tests without modifier -51, multiple procedures

Rather report times (x)

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The only CPT modifiers used in this section are -90 and -91.

The CPT manual lists the drugs most commonly tested for, although the use of codes is not limited to the drugs listed.

The modifier -51 is not used with pathology or laboratory codes. Instead, each test is listed separately.

Organ or Disease-Oriented Panels (80047-80081)

Groups of tests often ordered together

Example:

Basic Metabolic Panel

General Health Panel

Electrolyte Panel

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Codes in this subsection are grouped according to the usual laboratory work ordered by the physician for the diagnosis of, or screening for, various diseases or conditions.

Groups of tests may be performed together, depending on the situation or disease.

Rules of Panels

All tests must have been conducted and be medically necessary

Do not use modifier -52, Reduced Service

Additional tests, over those in panel, reported separately

If all tests in panel not performed

List each test separately

Do not use panel code

Problem oriented in scope

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All tests in the panel description must have been conducted if the coder is to code for the panel.

If the entire panel is not completed, you would code each test separately.

Presumptive Drug Class Screening (80305-80307) (1 of 3)

Divided by methods

Three different method categories include:

Optical observation (80305)

Instrument assisted (80306)

Instrument chemical analyzers (80307)

Identifies presence or absence of drug

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Drug screening is an analysis, which identifies the presence or absence of a drug.

Code this carefully. Understand that you can code the number of procedures performed, not the number of drugs being tested for.

Which code is reported if screening is performed visually? (80305)

Presumptive Drug Class Screening (80305-80307) (2 of 3)

Chromatography: procedure in which single or multiple drugs identified

Reports chromatography procedure(s)

Screening(s) is presumptive

Report 80307

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The thin layer chromatography drug screen is presumptive for single or multiple drug class method, per date of service and reported with 80307.

Presumptive Drug Class Screening (80305-80307) (3 of 3)

Does not identify amount of drug present

Only presence or absence

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The drug screening codes only tell if the drug is present, not the amount of the drug present.

Therapeutic Drug Assays (80143-80299)

Reports presence and amount (quantitative) or absence of a substance

Material examined can be from any source

Drugs listed by generic names

Example: Amitriptyline generic name for brand name Elavil

PDR a must for coding drug assays

Measures peaks (after drug given at intervals) and troughs (before drug given next dose)—used to monitor therapeutic drug for medication adjustment

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Which codes are used for therapeutic drug assays? (80143-80299)

Drug assays test to detect a specific drug and to quantify the amount of that drug that is present.

What does quantitative information determine?

The presence of a drug

The exact amount present

A coder should have a drug reference (example: Mosby’s Drug Consult) handy to look up generic names of drugs that are listed by brand name in the medical documentation.

Drugs in the CPT manual are listed by generic, not brand, name.

Evocation/Suppression Testing (80400-80439) (1 of 2)

Measures stimulating (evocative—calling forth a response) or suppressing agents

Codes report only TC of service

Modifier -TC = Technical Component

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This testing is performed to measure the effects of stimulating (evocative) or suppressing agents on chemical constituents.

Do you know:

Which codes are used to report supplies and/or drugs used in testing?

Which code is used if the physician administered the agent?

Which code is used if the test involved prolonged attendance by the physician?

Evocation/Suppression Testing(80400-80439) (2 of 2)

Additional services to report:

Supplies and/or drugs used in testing (99070 and/or HCPCS J codes)

E/M for physician monitoring of testing

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If the physician supplies the agent, use code 99070.

If the physician administers the agent, refer to code range 90760, 90761, 90772-90775.

If the test involves prolonged attendance by the physician, use appropriate E/M code.

Consultations (Clinical Pathology) (80500, 80502)

At request of physician

Additional information about specimen

Consultant prepares written report

Levels

Limited: Without review of medical record

Comprehensive: With review of medical record

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At the request of a primary care physician, a clinical pathologist may be requested to perform a consultation to offer additional medical interpretation.

Consultations may be limited or comprehensive.

More Consultation Codes

Surgical Pathology, 88321-88334

Used when pathologist either

Reviews slides, material, or reports

Provides consultation during surgery

Reported on specimen, block, section, cytologic exam

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Consultation codes are also found in the Surgical Pathology subsection.

What is included in the consultation codes? (Reviewing of slides, materials, or a report. The consultation is provided typically during surgery.)

Pathology Terminology

Specimen: Sample of tissue of suspect area

Block: Frozen piece of specimen

Section: Slice of frozen block

Example: Pathologist consults during surgical procedure

Examines one block = 88331

Examines each additional section of same block = 88332

Figure 25.2

Courtesy National Institute of Environmental Health Sciences—National Institutes of Health.

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Note that each specimen may be reported separately, but each slide from that specimen may not.

When one block is sectioned and examined, the service of examining the first section is reported with the use of 88331.

The second section, as well as subsequent sections of the same block, functions as an add-on code. But it is not marked as an add-on code.

Urinalysis (81000-81099) (1 of 2)

Tests on urine

Method of test

e.g., tablet, reagent, or dipstick

Reason for test

e.g., pregnancy

Constituents being tested for

e.g., bilirubin, glucose

From Proctor DB, Adams AP: Kinn's The Medical Assistant: An Applied Learning Approach, ed 12, St. Louis, 2014, Saunders.

Figure 25.3

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What are six things for the coder to remember when he or she is coding Urinalysis and Chemistry subsections? (1. The identification of specific tests; 2. Whether the test is automated or nonautomated; 3. The number of tests performed; 4. The identification of combination codes for similar types of tests; 5. Whether the results are qualitative or quantitative; and 6. The method of testing used)

Urinalysis (81000-81099) (2 of 2)

Equipment used

Automated or nonautomated

With or without microscope

Number of tests performed

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Codes for Urinalysis subsection? (81000-81099)

Urinalysis codes are for nonspecific tests done on urine.

What is the difference between an automated and nonautomated test? (Automated is done by a machine, whereas nonautomated is done manually.)

Chemistry (82009-84999) (1 of 2)

Specific tests on any bodily substances

Urine

Blood

Most chemistry tests are quantitative (specific amount) unless specified qualitative

Breath

Feces

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Codes for Chemistry subsection? (82009-84999)

Chemistry tests are performed on any bodily substance.

Codes are in alphabetical order in the CPT book.

What is the difference between quantitative and qualitative testing? (Qualitative is the presence of, while quantitative is how much is present.)

Chemistry (82009-84999) (2 of 2)

Samples from different sources, reported separately

e.g., blood, feces

Samples taken at different times of day reported separately

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Would a blood test and a feces test be reported separately? (Yes, different specimens)

If blood was drawn to check a potassium level at 8:00 AM and again at 2:00 PM, would both of these tests be billable? (Yes, because even though it is the same test performed twice, they were performed at different times of that day.)

Molecular Pathology (81105-81408, 81479)

81105-81383 are Tier 1 procedures that report molecular assay

More common gene specific procedures

Example, breast cancer gene–81162 (BRCA1 and BRCA2)

81400-81408 are Tier 2 procedures to report less commonly performed analyses

81479 reports unlisted molecular pathology procedures

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Genes are described using the Human Genome Organization (HUGO) names and definitions.

Analyses of nucleic acid to detect variants in genes that may indicate disorders or neoplasia.

When a physician interpretation is required, modifier -26 is appended to the specific molecular pathology code.

Hematology and Coagulation (85002-85999)

Laboratory procedures on blood

Example

Complete blood count (CBC)

White blood cell count (WBC)

Codes divided based on method of

Blood draw

Test being conducted

Figure 25.4

From Abbott: CELL-DYN Emerald 22 Hematology Analyzer (website): https://www.corelaboratory.abbott/us/en/offerings/brands/cell-dyn/cell-dyn-emerald22. Accessed August 8, 2018.

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What does the Hematology and Coagulation subsection report? (Various blood-drawing methods and tests)

The method used to perform the test is often what determines the code assignment.

What should coders do when there are many variations of just one test? (They should read the patient record and the code descriptions carefully before they assign a code.)

How are codes for blood coagulation tests divided? (According to the particular factor that is being tested)

Immunology (86000-86804)

Identifying immune system conditions caused by antibodies and antigens

Example: Hepatitis C antibody screening

Tissue typing (86805-86849)

Basic assay, screening, typing

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Immunology codes report tests that identify immune system conditions caused by antibodies and antigens.

Examples of such conditions? (Hypersensitivity, allergic reactions, immunity, alterations of body tissue)

Tissue Typing (86805-86849)

Compatibility test on tissue

Match donor to recipient

Measure/monitor cytotoxic reactions

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Transfusion Medicine (86850-86999)

Blood bank codes

Tests performed on blood or blood products

Do NOT identify supply of blood, but

Collection

Processing

Typing

Figure 25.5

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The subsection deals with tests performed on blood or blood products.

These tests include screening for antibodies, Coombs testing, autologous blood collection and processing, blood typing, compatibility testing, and preparation of and treatment performed on blood and blood products.

Microbiology (87003-87999)

Study of microorganisms

Identification of organism

Sensitivities of organism to antibiotics

From Mandell GL, Bennett JE, Dolin R: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, ed 7, Philadelphia, 2010, Churchill Livingstone.

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Microbiology deals with the study of microorganisms and includes the following:

Bacteriology

Mycology

Parasitology

Virology

What is bacteriology? (Study of bacteria)

What is mycology? (Study of fungi)

What is parasitology? (Study of parasites)

What is virology? (Study of viruses)

Microbiology Caution

Many code descriptions similar to those in Immunology (86000-86849)

Difference is technique used

Figure 25.6

Courtesy United States Environmental Protection Agency.

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Culture codes need to be read carefully because some codes are used only to detect the presence of an organism and others show additional sensitivity testing to determine which antibiotic would be best to use for treatment.

Anatomic Pathology (88000-88099)

Postmortem examinations

Autopsies

Reports only physician service

Codes divided on extent of exam and type of exam (gross versus gross and microscope)

Example:

Gross exam without central nervous system (88000)

Gross and microscopic without central nervous system (88020)

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Postmortem exams:

Deal with examination of the body after death.

Autopsy codes are divided by gross exam only or gross and microscopic. These are further divided on what the autopsy consisted of.

For example: an autopsy with gross and microscopic exam, with brain and spinal cord (88027).

Cytopathology (88104-88199)

Identify cellular changes

Common laboratory procedures

e.g., Pap smear

Codes divided on

Type of procedure

Technique used

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Cytopathology deals with laboratory work performed to determine whether any cellular changes have occurred.

Most common code is the Pap smear.

Cytogenetic Studies (88230-88299)

Branch of genetics concerned with cellular abnormalities and pathologic conditions

Example: Chromosomes

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Cytogenetic studies include tests that are performed for genetic and chromosomal studies.

Why may a test be performed from this subheading? (To rule out inheritance of a disorder)

Surgical Pathology (88300-88399) (1 of 3)

Evaluation of specimens to determine disease pathology

All tissue removed during procedures undergoes pathology evaluation

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These codes are concerned with the evaluation of specimens to determine the pathology of disease processes.

Pathology testing is performed on all tissue removed from the body.

The codes 88300-88399 include accessing them, examination of the specimen, and reporting of the findings.

The unit of service for these codes is the specimen.

Surgical Pathology (88300-88399) (2 of 3)

Operative report usually coded after pathology report received

Pathology reports usually coded with OR

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The diagnosis for the operative procedure is taken from the pathology report if pathology was performed.

If a patient had a chronic cough and the operative report was billed as a chronic cough but later the pathology report comes back as pneumococcal pneumonia. The cough was just a symptom of the pneumonia, which is why you should always wait for the pathology report.

Surgical Pathology (88300-88399) (3 of 3)

Unit of measure (88300-88309), specimen

Two anus tags, each examined, 88304 x 2

One anus tag examined in two different areas of tag, 88304

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If two specimens from the same area are received and examined, each specimen is coded.

What is a specimen? (Tissue submitted for examination)

The number of specimens equals the number of units.

Types of Pathologic Examination

Microscopic: With microscope

Gross: Without microscope

88300, only gross exam code

Others gross and microscopic

Courtesy of Cynmar Corporation, Carlinville, IL

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Microscopic examination cannot be seen with the naked eye.

Gross examination is large enough to see without a microscope.

Six Levels of Surgical Pathology (1 of 2)

Based on specimen examined

e.g., breast, prostate, lung

And reason for evaluation

e.g., radical procedure for suspected carcinoma

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In assigning the correct code, the coder must identify the source of the specimen and the reason for the surgical procedure.

The higher the level of surgical pathology the more complex the examination.

Six Levels of Surgical Pathology (2 of 2)

Levels divided on complexity of examination

Examples:

88305: Colon, biopsy

88307: Colon, segmental resection, other than for tumor

88309: Colon, total resection

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Surgical pathology is divided by the area of the body and the complexity of the procedure.

How many levels of Surgical Pathology are there? (Six)

Levels

Level I

Specimen can be diagnosed without microscopic examination

Level II

Gross and microscopic examination performed

Levels III, IV, V, and VI

Includes gross and microscopic examination and additional physician work (increasing difficulty)

Based upon method of or need for removal

Same anatomical site can be listed in each level

The Gram stain. Red blood cells (RBC) and gram-positive cocci.

From McPherson RA, Pincus MR: Henry’s Clinical Diagnosis and Management by Laboratory Methods, ed 22, St. Louis, 2011, Saunders.

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Knowing these different levels makes coding for surgical pathology easier.

Always look under the code in the CPT manual to find if the specimen and surgical procedure fall there.

Not Included In Codes 88300-88309

Additional service codes 88311-88399 are not included in codes 88300-88309

Example: Special stains (88312)

Additional services reported separately

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Which codes are used for additional services? (88311-88399)

Remember, additional services must be reported separately.

ConclusionCHAPTER 25

PATHOLOGY / LABORATORY

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Chapter_025.pptx

Chapter_025.pptx

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