Pathology & Laboratory By Alejandra Munoz, CPC, NCICS

Types of Pathology and Laboratory Organ or Disease-Oriented Panels Drug Testing Therapeutic Drug Assays Evocative/Suppression Testing Consultations (Clinical Pathology) Urinalysis Molecular Pathology Chemistry Hematology and Coagulation Immunology Transfusion Medicine Microbiology Anatomic Pathology Cytogenetic Studies Surgical Pathology Transcutaneous Procedures Other Procedures Reproductive Medicine Procedures

Pathology & Laboratory  Codes for laboratory tests only.  Specimen collection coded separately  Example: Venus blood draw reported (surgery section)

Facility Indicators  Allow additional tests without physician written order  Example: Urinalysis positive for bacteria  Built-in indicator for culture

Pathology/Lab caution  Usually report second or subsequent tests without -51 (modifier), multiple procedures  Rather report times (x)

Organ or Disease-oriented Panels ( )  Groups of tests often ordered together  Examples:  Basic Metabolic panel  General Health panel  Electrolyte panel

Rules of Panels  All tests must have been conducted and be medically necessary  Do not use -52, Reduced Service  Additional tests, over those in panel, reported separately  If all test in panel not performed:  List each test separately  Do not use panel code  Problem oriented scope

Drug Testing ( )  Lists drug screening, drug confirmation, and tissue preparation services  Identifies presence or absence of drug – qualitative analysis  Confirmation conducted to double check results of positive drug test (80102)

Drug Testing, Cont…  Chromatography” Procedure in which multiple drugs identified.  Some machines identify all drugs present in one procedure  Others require two or more procedures to identify two or more drugs

Drug Testing, Cont..  Code the number of procedures, not the number of drugs tested for.  Example:  Two procedures to identify three drugs: x 2  One procedure to identify three drugs: 80100

Therapeutic Drug Assays  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 testing  Measures peaks (after drug given at intervals) and troughs (before drug given) – used to monitor therapeutic drug medication adjustment

Evocation/Suppression Testing ( )  Measures stimulating (evocative – calling forth a response) or suppressing agents  Codes report only TC of service  TC= Technical Component

Evocation/Suppression Testing  Additional services to report:  Supplies and/or drugs used in testing (99070 and/or HCPCS J codes)  E/M for physician monitoring of testing

Consultations (Clinical pathology)  At request of physician  Additional information about specimen  Consultant prepares written report  Levels  Limited: Without review of medical records  Comprehensive: With review of medical record

More Consultation codes…  Surgical pathology ( )  Used when pathologist either:  Reviews slides, material, or reports  Provides consultation during surgery  Reported on specimen, block, section, cytologic exam

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=  Examines each additional section of same block= 88332

Urinalysis ( )  Tests on urine  Method of test  e.g., tablet, or dipstick  Reason for test  e.g., pregnancy  Constituents being tested for  e.g., bilirubin, glucose

Urinalysis, cont…  Equipment used  Automated or non automated  With or without a microscope  Number of test performed

Chemistry ( )  Specific tests on any bodily substance  Urine  Blood  Breath  Feces  Most chemistry tests are quantitative (specific amount) unless specified qualitative

Chemistry, Cont…  Samples from different sources, reported separately  e.g., blood, feces  Samples taken at different times of days reported separately

Molecular pathology Procedures ( )  are Tier 1 procedures that report molecular assay  More common gene specific procedures  Example: Breast cancer gene  are Tier 2 procedures to report less commonly performed analyses

Hematology and Coagulation ( )  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

Immunology ( )  Identifying immune system conditions caused by antibodies and antigens  Example: Hepatitis C antibody screening  Tissue typing  Basic assay, screening, typing

Transfusion Medicine ( )  Blood bank codes  Test performed on blood or blood products  Do NOT identify supply of blood, but  Collection  Processing  typing

Surgical Pathology ( )  Evaluation of specimens to determine disease pathology  All tissue removed during procedures undergoes pathology evaluation

Types of Pathologic Examination  Microscopic: With microscope  Gross: Without microscope  88300, only gross exam code  Other gross AND microscopic

Levels  Level I  Specimen can be diagnosed without microscopic examination  Level II  Gross and microscopic examination performed  Level III, IV, V, VI  Includes gross and microscopic examination and additional physician work  Based upon method of or need for removal  Same anatomic site can be listed in each level

Reference:  Buck, C (2010). Step by Step. Elsevier.