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

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

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

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 a technical and professional component.

Exercise 17.1 Although most clinical laboratory service codes include a technical component, some include both a technical and a __________ component.

Pathology and Laboratory Sections Organization According to procedure performed Procedures listed alphabetically within each subsection Review patient record documentation, code descriptions, and instructional notes Hospitals include pathology and laboratory codes on a chargemaster, which is used to report services and supplies for inpatient, outpatients and emergency department patients.

Exercise 17.1 Review of patient record documentation is necessary before assigning pathology and laboratory codes because many procedures can be performed using different ________.

Exercise 17.1 Hospital codes usually do not assign pathology and laboratory codes because they are included on a __________________, which is used by providers to select services provided to patients.

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

Exercise 17.1 CPT laboratory codes describe the performance of lab tests, and they do not include collection of the _________, which is performed using different methods (e.g., venipuncture, fingerstick, or lumbar puncture ) and is reported separately.

Exercise 17.1 The puncture of a vein using a needle for the purpose of drawing blood as a common method of collecting blood specimens is called venipuncture, or ___________________.

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

Exercise 17.1 A routine venipuncture (usually performed by a nurse) is assigned code __________, and it is reported in addition to the laboratory procedure code.

Exercise 17.1 7. When a physician’s sill is required to perform the procedure, a code from range __________ is assigned.

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)

Exercise 17.1 8. When a pathology and laboratory procedure code description includes technical and professional components, and both components were not performed, modifier _________ is added to the code to indicate that only the professional component was performed.

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

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

Exercise 17.1 When an outside laboratory performs pathology and laboratory services, add modifier ________ to a reported code.

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

Exercise 17.1 To perform certain pathology and laboratory tests (and to submit claims to Medicare and Medicaid), physician office labs must obtain certification under the _____________.

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

Exercise 17.2 The unit of pathology service is a _______, which is tissue submitted for individual and separate examination and pathological diagnosis.

Exercise 17.2 During the same operative session, the surgeon Submitted “incidental appendix” tissue and a Section of fallopian tube (as a result of a sterilization procedure) for pathological evaluation. Refer to the notes located below the Surgical Pathology subsection (codes 88300-88399) To determine whether one or two codes are reported. Code 88302 is reported _________ (once/twice).

Exercise 17.2 It is appropriated to separately code and report multiple pathology and laboratory procedures that are provided on the same _____________.

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 (continued)

Exercise 17.2 A service or procedure that is provided for which there is no CPT code is reported with an ______________ code , and a __________ is attached to the submitted claim.

Special Report May include: 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 are repeated on same date of service in order to obtain multiple results

Exercise 17.2 When procedures or services are repeated on the same date of service to obtain multiple results, add modifier _________ to the reported pathology and laboratory codes. it is not appropriated to add modifier ______ to pathology and laboratory codes.