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Unit 8 Presentation Chapter 17

CPT Pathology and Laboratory

Shatondra Surulere, MBA, RHIA, CCs

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Overview of Pathology and Laboratory Section

CPT Pathology and Laboratory codes describe services performed on specimens (such as body fluids, tissue or cytological specimens)

The services are used to evaluate, prevent, diagnose, or treat a disease.

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Laboratory Examinations

Biophysical Chemical Cytological Hematological Immunohematological Microbiological Pathological Serological

Pap Smear

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Specimen

Tissue submitted for laboratory or pathological evaluation Blood Urine Tissue from an organ

Example is an appendix that is removed and sent to pathology or a wound culture of an infected decubitus ulcer of the sacrum.

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Specimen Collection

Specimen collection is not included in the code for the performance of the test.

Venipunctures, arterial punctures, lumbar punctures, or collection performed by staff are separate codes.

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Laboratory and Pathological Service Codes

Most clinical laboratory service codes include a technical component.

Some services include both a technical and professional component.

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Professional and Technical Components

Certain laboratory procedures contain both a professional (e.g., physician) and technical component Technical component includes cost of

equipment, supplies, and technician salaries

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Clinical Pathology

Professional services include: Directing and evaluating quality

assurance and control procedures Supervising laboratory technicians Recommending follow-up diagnostic

tests

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Coding Tip

When pathology/laboratory service code description includes both the technical and professional component, and both components were not performed, report the appropriate code with its modifier: -26 (professional component only

provided) -TC (technical component only provided)

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National Coverage Determinations (NCD)

Define coverage for services and procedures

Developed by CMS to: Simplify administrative requirements

for clinical diagnostic services Promote national uniformity in

processing Medicare claims Medicare administrative

contractors apply NCDs nationwide

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Coding Tip

When reporting CLIA-waived services to Medicare or Medicaid, add HCPCS level II modifier -QW to pathology and laboratory codes.

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Pathology and Laboratory Sections

Organization According to procedure performed Procedures listed alphabetically within

each subsection Review patient record

documentation, code descriptions, and instructional notes

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Pathology and Laboratory Section Guidelines

Located at beginning of Pathology and Laboratory section

Provide instruction about: Services for pathology and

laboratory Separate or multiple procedures Subsection information Unlisted services or procedures Special reports

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Special Report

Submitted when unlisted procedure or service code is reported on claim

Attached to submitted claim to clarify service or procedure performed

Should include description of nature, extent, and need for procedure

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Special Report

May include: Complexity of symptoms Final diagnosis Pertinent physical findings Diagnostic and therapeutic procedures Concurrent problems Follow-up care

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Coding Tip

Modifier -90 [reference (outside) laboratory] is reported to indicate that an outside laboratory performed the service.

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Clinical Laboratory Improvement Act (CLIA)

Physician office labs must obtain certification to: Perform certain

pathology and laboratory tests

Submit claims to Medicare and Medicaid

Chemstrip Automated Urine Analyzer

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Modifiers

-51 (multiple procedures) Not added to pathology and laboratory

codes -91 (repeat clinical diagnostic

laboratory test) Added when procedures or services are

repeated on same date of service in order to obtain multiple results

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Subsections

Organ or disease-oriented panels

Drug testing Therapeutic drug assays Evocative/Suppression

testing Consultations (clinical

pathology) Urinalysis

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Subsections

Chemistry Hematology and

coagulation Molecular

diagnostics Transfusion

medicine Microbiology Anatomic

pathology

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Subsections

Cytopathology Cytogenetic

studies Surgical pathology Transcutaneous

procedures Other procedures Reproductive

medicine procedures

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Organ/Disease-Oriented Panels

Organ or disease oriented panels are report for a defined group of tests, administered for a certain purpose. Comprehensive metabolic panel (CMP)

When one or several tests are performed, do not report panel code Report codes for each, individual test

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Questions