CPT Pathology and Laboratory Chapter 17 CPT Pathology and Laboratory

Subsections Organ or disease-oriented panels Drug testing Therapeutic drug assays Evocative/suppression testing Consultations (clinical pathology) Urinalysis (continued)

Subsections Chemistry Hematology and coagulation Molecular diagnostics Transfusion medicine Microbiology Anatomic pathology

Chemstrip Automated Urine Analyzer Courtesy of Boehringer Mannheim Corp., Indianapolis, IN.

Dipstick for Routine Urinalysis Delmar/Cengage Learning

Serological Centrifuge Courtesy of Becton Dickinson Primary Care Diagnostics. Clay Adams and SEROFUGE are trademarks of Becton Dickinson and Company.

Subsections Cytopathology Cytogenetic studies Surgical pathology Transcutaneous procedures Other procedures Reproductive medicine procedures

Performing a Pap Smear Delmar/Cengage Learning

Tissue Biopsy Delmar/Cengage Learning

Overview of Pathology and Laboratory Section Describes services performed on specimens to evaluate, prevent, diagnose, or treat disease e.g., body fluids, tissue, cytological specimens

Laboratory Examinations Biophysical Chemical Cytological Hematological Immunohematological (continued)

Laboratory Examinations Microbiological Pathological Serological

Laboratory Service Codes Most clinical laboratory service codes include a technical component Some services include both technical and professional components

Pathology and Laboratory Sections Organization According to procedure performed Procedures listed alphabetically within each subsection Review patient record documentation, code descriptions, and instructional notes

Specimen Collection Laboratory codes describe performance of lab tests Codes do not include collection of specimen Reported separately

Urine Collection Containers Delmar/Cengage Learning

Professional and Technical Components Certain laboratory procedures contain both professional (e.g., physician) and technical components Technical component includes cost of equipment, supplies, and technician salaries

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

Clinical Pathology Professional services include the following: Directing and evaluating quality assurance and control procedures Supervising laboratory technicians Recommending follow-up diagnostic tests

Coding Tip Modifier -90 [reference (outside) laboratory] reported to indicate outside laboratory performed service

Clinical Laboratory Improvement Act (CLIA) Physician office labs must obtain certification to: Perform certain pathology and laboratory tests Submit claims to Medicare and Medicaid

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

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

Pathology and Laboratory Section Guidelines Located at beginning of Pathology and Laboratory section (continued)

Pathology and Laboratory Section Guidelines Provide instruction about: Services for pathology and laboratory Separate or multiple procedures Subsection information Unlisted services or procedures Special reports

Special Report Submitted when unlisted procedure or service code reported on claim Attached to submitted claim to clarify service or procedure performed Should include description of nature, extent, and need for procedure (continued)

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

Modifiers -51 (multiple procedures) Not added to pathology and laboratory codes -91 (repeat clinical diagnostic laboratory test) Added when procedures or services repeated on same date of service to obtain multiple results

Organ/Disease-Oriented Panels When one or several tests performed, do not report panel code Report codes for each, individual test