2018

Laboratory Essential links from CPT® codes to ICD-10-CM and HCPCS

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Cross Coder

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© 2017 Optum360, LLC © 2017 American Medical Association. All Rights Reserved. i

ContentsIntroduction ...................................................................................i

Organ or Disease-Oriented Panels ................................................1

Drug Assay...................................................................................13

Drug Testing ................................................................................22

Therapeutic Drug Assays.............................................................49

Evocative/Suppression Testing...................................................54

Urinalysis .....................................................................................61

Molecular Pathology ...................................................................62

Chemistry ....................................................................................87

Hematology and Coagulation ...................................................291

Immunology ............................................................................. 315

Transfusion Medicine ............................................................... 389

Microbiology ............................................................................ 391

Anatomic Pathology................................................................. 416

Cytopathology.......................................................................... 417

Cytogenetic Studies ................................................................. 421

Surgical Pathology ................................................................... 423

Other Procedures ..................................................................... 428

Reproductive Medicine Procedures ......................................... 431

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© 2017 Optum360, LLC © 2017 American Medical Association. All Rights Reserved. i

IntroductionOptum360 is pleased to present the 2017 Laboratory Cross Coder. Fully comprehensive, Laboratory Cross Coder links most CPT® laboratory codes to corresponding ICD-10-CM diagnosis and HCPCS Level II codes. Optum360 believes that professional coders working in laboratories, physician’s offices, clinical outpatient areas, hospitals, as well as payer settings will embrace this reference.

Laboratory Cross Coder is based on the Pathology and Laboratory section of the Current Procedural Terminology (CPT). Up-to-date CPT laboratory codes link to the following related medical coding systems:

• International Classification of Diseases, 10th Revision, ClinicalModification (ICD-10-CM)

• Healthcare Common Procedural Coding System (HCPCS) Level II

All coding relationships in Laboratory Cross Coder spring from CPT’s pathology and laboratory codes and the term “CPT-driven” is sometimes heard. But it is perhaps more appropriate to think of this reference book as “data driven.” A team of clinical and coding experts launched Laboratory Cross Coder by first reviewing data drawn from the Optum360 information base of nationwide medical claims. Pertinent laboratory-related coding relationships were drawn from the data stream and processed for coding errors and other anomalies. From this early cut of data emerged a general clinical picture of each laboratory code, but data analysis for Laboratory Cross Coder had hardly begun.

Some CPT codes are omitted from the listing because consistent and reliable cross-links are almost impossible to establish. Unlisted procedure codes are an obvious example. Certain types of add-on codes are also treated somewhat differently in Laboratory Cross Coder. These codes are discussed in greater detail under the CPT Codes section later in this Introduction. As a data-driven coding reference, Laboratory Cross Coder presents most likely scenarios as derived from clinical information sources. However, Laboratory Cross Coder is not a substitute for ICD-10-CM or any other medical coding reference and users are urged to regularly consult all available sources. The absence of any specific code does not necessarily indicate that its association to the base procedure code is inappropriate. Assuming all rules of laboratory coding are followed, excepted diagnosis codes may prove appropriate to a specific code scenario.

Laboratory Cross Coder does not include coding rules or guidelines. Once again, the user is urged to consult the original coding reference (e.g., CPT, ICD-10-CM, HCPCS Level II, etc.) or one of several reputable medical coding instruction manuals.

FormatAn understanding of the Laboratory Cross Coder format allows users to easily navigate its content. Information within the main section ties to the CPT book and the codes are presented in the same numeric order as the pathology and laboratory section.

SectionsLaboratory Cross Coder provides linked information to the CPT code range 80047 to 89398. The codes are divided into the same sections as the Pathology and Laboratory section of the CPT book.

Codes and Code RangesThe data within each CPT code set of Laboratory Cross Coder is presented as follows:

• CPT code or code range

• CPT codes and descriptions

• ICD-10-CM diagnostic codes and descriptions

• HCPCS Level II codes and descriptions

For example:

Each CPT code or code range is followed by its specific ICD-10-CM and HCPCS Level II links. Laboratory Cross Coder presents full descriptions for all CPT codes and their links.

National Coverage DecisionsYour Laboratory Cross Coder also indicates when a service is subject to a National Coverage Decision (NCD) by placing NCD after the code. An NCD for a diagnostic laboratory test is a national policy statement granting, limiting, or excluding Medicare coverage for that test. An NCD will indicate Medicare policy regarding the circumstances under which the test will be considered reasonable and necessary. This is important because Medicare will not provide coverage for a service that is not medically necessary such as tests for screening purposes only or otherwise not indicated by the patient’s diagnosis. NCDs are applicable nationwide and must be adhered to by all Medicare contractors including fiscal intermediaries and carriers.

Each of the clinical diagnostic laboratory service NCDs contain lists of CPT codes identifying the service, indications and limitations of coverage, and ICD-10-CM codes that support the medical necessity of the procedure. Also included, when applicable, are any documentation requirements that may be necessary. NCDs are periodically updated so it is important that they be reviewed on a regular basis. The complete national coverage decisions may be found at: http://www.cms.gov/CoverageGenInfo/04_LabNCDs.asp.

Other PayersNon-governmental payers may follow the Medicare NCDs or they may develop their own policies on coverage of laboratory tests, either routine or advanced diagnostic testing. Always check with the insurance company for coverage criteria. Many may have on-line policies that can be reviewed.

8129081290 MCOLN1 (mucolipin 1) (eg, Mucolipidosis, type IV) gene

analysis, common variants (eg, IVS3-2A>G, del6.4kb)

ICD-10-CM Diagnostic CodesE75.11 Mucolipidosis IV

Z13.71 Encounter for nonprocreative screening for genetic disease carrier status

Z13.79 Encounter for other screening for genetic and chromosomal anomalies

Z31.5 Encounter for genetic counseling

HCPCS Level II Supplies & ServicesG0452 Molecular pathology procedure; physician interpretation

and report

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80074 - NCDAcute hepatitis panel This panel must include the following: Hepatitis Aantibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb),IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) HepatitisC antibody (86803)

80074

ICD-10-CM Diagnostic CodesHepatitis A with hepatic comaB15.0Hepatitis A without hepatic comaB15.9Acute hepatitis B with delta-agent with hepatic comaB16.0Acute hepatitis B with delta-agent without hepatic comaB16.1Acute hepatitis B without delta-agent with hepatic comaB16.2Acute hepatitis B without delta-agent and without hepatic comaB16.9Acute delta-(super) infection of hepatitis B carrierB17.0Acute hepatitis C without hepatic comaB17.10Acute hepatitis C with hepatic comaB17.11Acute hepatitis EB17.2Other specified acute viral hepatitisB17.8Chronic viral hepatitis B with delta-agentB18.0Chronic viral hepatitis B without delta-agentB18.1Chronic viral hepatitis CB18.2Other chronic viral hepatitisB18.8Postviral fatigue syndromeG93.3Esophageal varices without bleedingI85.00Esophageal varices with bleedingI85.01Secondary esophageal varices without bleedingI85.10Secondary esophageal varices with bleedingI85.11Alcoholic hepatic failure with comaK70.41Toxic liver disease with cholestasisK71.0Toxic liver disease with hepatic necrosis, without comaK71.10Toxic liver disease with hepatic necrosis, with comaK71.11Toxic liver disease with acute hepatitisK71.2Toxic liver disease with chronic persistent hepatitisK71.3Toxic liver disease with chronic lobular hepatitisK71.4Toxic liver disease with chronic active hepatitis without ascitesK71.50Toxic liver disease with chronic active hepatitis with ascitesK71.51Toxic liver disease with hepatitis, not elsewhere classifiedK71.6Toxic liver disease with fibrosis and cirrhosis of liverK71.7Toxic liver disease with other disorders of liverK71.8Acute and subacute hepatic failure without comaK72.00Acute and subacute hepatic failure with comaK72.01Chronic hepatic failure without comaK72.10Chronic hepatic failure with comaK72.11Hepatic fibrosisK74.0Other cirrhosis of liverK74.69Abscess of liverK75.0Phlebitis of portal veinK75.1Nonspecific reactive hepatitisK75.2Granulomatous hepatitis, not elsewhere classifiedK75.3Nonalcoholic steatohepatitis (NASH)K75.81Other specified inflammatory liver diseasesK75.89Central hemorrhagic necrosis of liverK76.2Peliosis hepatisK76.4Portal hypertensionK76.6Hepatorenal syndromeK76.7Hepatopulmonary syndromeK76.81Acute abdomenR10.0Right upper quadrant painR10.11Left upper quadrant painR10.12Epigastric painR10.13Pelvic and perineal painR10.2Right lower quadrant painR10.31Left lower quadrant painR10.32Periumbilical painR10.33Right upper quadrant abdominal tendernessR10.811Right upper quadrant rebound abdominal tendernessR10.821

ColicR10.83Generalized abdominal painR10.84NauseaR11.0Vomiting without nauseaR11.11Projectile vomitingR11.12Bilious vomitingR11.14Hepatomegaly, not elsewhere classifiedR16.0Hepatomegaly with splenomegaly, not elsewhere classifiedR16.2Neoplastic (malignant) related fatigueR53.0WeaknessR53.1Functional quadriplegiaR53.2Other malaiseR53.81Other fatigueR53.83Simple febrile convulsionsR56.00Complex febrile convulsionsR56.01Post traumatic seizuresR56.1Delayed milestone in childhoodR62.0Failure to thrive (child)R62.51Short stature (child)R62.52Other lack of expected normal physiological development in childhoodR62.59AnorexiaR63.0PolydipsiaR63.1PolyphagiaR63.2Feeding difficultiesR63.3Abnormal weight lossR63.4Abnormal weight gainR63.5UnderweightR63.6Nonspecific elevation of levels of transaminase and lactic aciddehydrogenase [LDH]

R74.0

Abnormal results of liver function studiesR94.5Liver transplant rejectionT86.41Liver transplant failureT86.42Liver transplant infectionT86.43Other complications of liver transplantT86.49Encounter for general adult medical examination without abnormal findingsZ00.00Encounter for general adult medical examination with abnormal findingsZ00.01Encounter for preprocedural laboratory examinationZ01.812Encounter for other specified special examinationsZ01.89

HCPCS Level II Supplies & ServicesTravel allowance, one way in connection with medically necessary laboratoryspecimen collection drawn from homebound or nursing homebound patient;prorated miles actually travelled

P9603

Travel allowance, one way in connection with medically necessary laboratoryspecimen collection drawn from homebound or nursing homebound patient;prorated trip charge

P9604

80076Hepatic function panel This panel must include the following: Albumin(82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline(84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT)(84460) Transferase, aspartate amino (AST) (SGOT) (84450)

80076

ICD-10-CM Diagnostic CodesAmebic liver abscessA06.4Syphilis of liver and other visceraA52.74Hepatitis A with hepatic comaB15.0Hepatitis A without hepatic comaB15.9Acute hepatitis B with delta-agent with hepatic comaB16.0Acute hepatitis B with delta-agent without hepatic comaB16.1Acute hepatitis B without delta-agent with hepatic comaB16.2Acute hepatitis B without delta-agent and without hepatic comaB16.9Acute delta-(super) infection of hepatitis B carrierB17.0Acute hepatitis C without hepatic comaB17.10Acute hepatitis C with hepatic comaB17.11Acute hepatitis EB17.2

NCD — National Coverage Decision© 2017 Optum360, LLC11: Male diagnosis; Female diagnosis[Resequenced code]CPT © 2017 American Medical Association. All Rights Reserved.

80076Laboratory Cross Coder

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Chemistry82009-82010

Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate);qualitative

82009

quantitative82010

ICD-10-CM Diagnostic CodesDrug or chemical induced diabetes mellitus with ketoacidosis without comaE09.10Type 1 diabetes mellitus with ketoacidosis without comaE10.10Type 1 diabetes mellitus with ketoacidosis with comaE10.11Type 1 diabetes mellitus with hypoglycemia with comaE10.641Other specified diabetes mellitus with ketoacidosis without comaE13.10Other specified diabetes mellitus with ketoacidosis with comaE13.11Alcohol abuse with intoxication, uncomplicatedF10.120Encounter for general adult medical examination without abnormal findingsZ00.00Encounter for general adult medical examination with abnormal findingsZ00.01Encounter for preprocedural laboratory examinationZ01.812

82013Acetylcholinesterase82013

ICD-10-CM Diagnostic CodesSickle-cell thalassemia with acute chest syndromeD57.411Sickle-cell thalassemia with splenic sequestrationD57.412Hereditary spherocytosisD58.0Congenital dyserythropoietic anemiaD64.4Other specified anemiasD64.89Poisoning by anticholinesterase agents, accidental (unintentional), initialencounter

T44.0X1A

Poisoning by anticholinesterase agents, intentional self-harm, initialencounter

T44.0X2A

Poisoning by anticholinesterase agents, assault, initial encounterT44.0X3APoisoning by anticholinesterase agents, undetermined, initial encounterT44.0X4APoisoning by other parasympathomimetics [cholinergics], accidental(unintentional), initial encounter

T44.1X1A

Poisoning by other parasympathomimetics [cholinergics], intentionalself-harm, initial encounter

T44.1X2A

Poisoning by other parasympathomimetics [cholinergics], assault, initialencounter

T44.1X3A

Poisoning by other parasympathomimetics [cholinergics], undetermined,initial encounter

T44.1X4A

Encounter for general adult medical examination without abnormal findingsZ00.00Encounter for general adult medical examination with abnormal findingsZ00.01Encounter for preprocedural laboratory examinationZ01.812

82016-82017Acylcarnitines; qualitative, each specimen82016

quantitative, each specimen82017

ICD-10-CM Diagnostic CodesLong chain/very long chain acyl CoA dehydrogenase deficiencyE71.310Medium chain acyl CoA dehydrogenase deficiencyE71.311Short chain acyl CoA dehydrogenase deficiencyE71.312Glutaric aciduria type IIE71.313Muscle carnitine palmitoyltransferase deficiencyE71.314Other disorders of fatty-acid oxidationE71.318Disorders of ketone metabolismE71.32Primary carnitine deficiencyE71.41Carnitine deficiency due to inborn errors of metabolismE71.42

Iatrogenic carnitine deficiencyE71.43Ruvalcaba-Myhre-Smith syndromeE71.440Other secondary carnitine deficiencyE71.448Encounter for general adult medical examination without abnormal findingsZ00.00Encounter for general adult medical examination with abnormal findingsZ00.01Encounter for preprocedural laboratory examinationZ01.812

82024-82030Adrenocorticotropic hormone (ACTH)82024Adenosine, 5-monophosphate, cyclic (cyclic AMP)82030

ICD-10-CM Diagnostic CodesMalignant neoplasm of cortex of right adrenal glandC74.01Malignant neoplasm of cortex of left adrenal glandC74.02Malignant neoplasm of medulla of right adrenal glandC74.11Malignant neoplasm of medulla of left adrenal glandC74.12Thyrotoxicosis with diffuse goiter without thyrotoxic crisis or stormE05.00Thyrotoxicosis with diffuse goiter with thyrotoxic crisis or stormE05.01Primary hyperparathyroidismE21.0Secondary hyperparathyroidism, not elsewhere classifiedE21.1Other hyperparathyroidismE21.2Acromegaly and pituitary gigantismE22.0HypopituitarismE23.0Drug-induced hypopituitarismE23.1Pituitary-dependent Cushing's diseaseE24.0Drug-induced Cushing's syndromeE24.2Ectopic ACTH syndromeE24.3Alcohol-induced pseudo-Cushing's syndromeE24.4Other Cushing's syndromeE24.8Congenital adrenogenital disorders associated with enzyme deficiencyE25.0Other adrenogenital disordersE25.8Other adrenocortical overactivityE27.0Primary adrenocortical insufficiencyE27.1Addisonian crisisE27.2Drug-induced adrenocortical insufficiencyE27.3Other adrenocortical insufficiencyE27.49Postprocedural hypopituitarismE89.3Postprocedural adrenocortical (-medullary) hypofunctionE89.6Major depressive disorder, single episode, mildF32.0Major depressive disorder, single episode, moderateF32.1Major depressive disorder, single episode, severe without psychotic featuresF32.2Major depressive disorder, single episode, severe with psychotic featuresF32.3Major depressive disorder, single episode, in partial remissionF32.4Encounter for general adult medical examination without abnormal findingsZ00.00Encounter for general adult medical examination with abnormal findingsZ00.01Encounter for preprocedural laboratory examinationZ01.812

82040-82043Albumin; serum, plasma or whole blood82040

urine or other source, quantitative, each specimen82042urine, microalbumin, quantitative82043

ICD-10-CM Diagnostic CodesPlasmodium malariae malaria with nephropathyB52.0Other malignant immunoproliferative diseasesC88.8Drug or chemical induced diabetes mellitus with diabetic nephropathyE09.21Drug or chemical induced diabetes mellitus with diabetic chronic kidneydisease

E09.22

Drug or chemical induced diabetes mellitus with other diabetic kidneycomplication

E09.29

NCD — National Coverage Decision© 2017 Optum360, LLC87: Male diagnosis; Female diagnosis[Resequenced code]CPT © 2017 American Medical Association. All Rights Reserved.

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