Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CHAPTER 24 PATHOLOGY / LABORATORY

2 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Types of Pathology and Laboratory Subsections such as: Organ or Disease-Oriented PanelsOrgan or Disease-Oriented Panels Drug TestingDrug Testing Therapeutic Drug AssaysTherapeutic Drug Assays Evocative/Suppression TestingEvocative/Suppression Testing Consultation (Clinical Pathology)Consultation (Clinical Pathology) UrinalysisUrinalysis ChemistryChemistry Hematology and CoagulationHematology and Coagulation ImmunologyImmunology Transfusion MedicineTransfusion Medicine MicrobiologyMicrobiology Anatomic PathologyAnatomic Pathology CytopathologyCytopathology Cytogenetic StudiesCytogenetic Studies Surgical PathologySurgical Pathology Transcutaneous ProceduresTranscutaneous Procedures Other ProceduresOther Procedures Reproductive Medicine ProceduresReproductive Medicine Procedures

3 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Pathology and Laboratory Codes for laboratory test onlyCodes for laboratory test only Specimen collection coded separatelySpecimen collection coded separately –Example: Venous blood draw reported (Surgery section) Medicare fee schedule each year identifies those lab tests associated with a physician component (-26)Medicare fee schedule each year identifies those lab tests associated with a physician component (-26) From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders. Figure: 24.1

4 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Facility Indicators Allow additional tests without physician written orderAllow additional tests without physician written order –Example: Urinalysis positive for bacteriaUrinalysis positive for bacteria –Built-in indicator for culture

5 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Pathology/Laboratory Caution Usually report second or subsequent tests without -51, multiple proceduresUsually report second or subsequent tests without -51, multiple procedures Rather report times (x)Rather report times (x)

6 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Organ or Disease-Oriented Panels ( ) Groups of tests often ordered togetherGroups of tests often ordered together –Example: Basic Metabolic PanelBasic Metabolic Panel General Health PanelGeneral Health Panel Electrolyte PanelElectrolyte Panel

7 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Rules of Panels All tests must have been conducted & be medically necessaryAll tests must have been conducted & be medically necessary Do not use -52, Reduced ServiceDo not use -52, Reduced Service Additional tests, over those in panel, reported separatelyAdditional tests, over those in panel, reported separately If all tests in panel not performedIf all tests in panel not performed –List each test separately –Do not use panel code Problem oriented in scopeProblem oriented in scope

8 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Drug Testing ( ) List drug screening, drug confirmation, and tissue preparation servicesList drug screening, drug confirmation, and tissue preparation services Identifies presence or absence of drug– qualitative analysisIdentifies presence or absence of drug– qualitative analysis Confirmation conducted to double check results of positive drug test (80102)Confirmation conducted to double check results of positive drug test (80102)(Cont’d…)

9 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Drug Testing (…Cont’d) Chromatography procedure in which multiple drugs identifiedChromatography 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 (Cont’d…)

10 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Drug Testing (…Cont’d) Code the number of procedures, not the number of drugs tested forCode the number of procedures, not the number of drugs tested for –Example: Two procedures to identify three drugs =  2Two procedures to identify three drugs =  2 One procedure to identify three drugs = 80100One procedure to identify three drugs = 80100(Cont’d…)

11 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Drug Testing (…Cont’d) Does not identify amount of drug presentDoes not identify amount of drug present –Only presence or absence Quantitative analysis tests for specific amount of analyte presentQuantitative analysis tests for specific amount of analyte present

12 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Therapeutic Drug Assays ( ) Report presence and amount (quantitative), or absence of a substanceReport presence and amount (quantitative), or absence of a substance Material examined can be from any sourceMaterial examined can be from any source Drugs listed by generic namesDrugs 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 next dose)— used to monitor therapeutic drug for medication adjustmentMeasures peaks (after drug given at intervals) and troughs (before drug given next dose)— used to monitor therapeutic drug for medication adjustment

13 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Evocation/Suppression Testing ( ) Measures stimulating (evocative— calling forth a response) or suppressing agentsMeasures stimulating (evocative— calling forth a response) or suppressing agents Codes report only TC of serviceCodes report only TC of service –TC = Technical Component (Cont’d…)

14 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Evocation/Suppression Testing (…Cont’d) Additional services to report:Additional services to report: –Supplies and/or drugs used in testing (99070 and/or HCPCS J codes) E/M for physician monitoring of testingE/M for physician monitoring of testing

15 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Consultations (Clinical Pathology) (80500, 80502) At request of physicianAt request of physician –Additional information about specimen –Consultant prepares written report LevelsLevels –Limited: Without review of medical record –Comprehensive: With review of medical record

16 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. More Consultation Codes Surgical Pathology, Surgical Pathology, Used when pathologist eitherUsed when pathologist either –Reviews slides, material, or reports –Provides consultation during surgery Reported on specimen, block, section, cytologic examReported on specimen, block, section, cytologic exam

17 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Pathology Terminology Specimen : Sample of tissue of suspect areaSpecimen : Sample of tissue of suspect area Block : Frozen piece of specimenBlock : Frozen piece of specimen Section : Slice of frozen blockSection : Slice of frozen block –Example: Pathologist consults during surgical procedure Examines one block = 88331Examines one block = Examines each additional section of same block = 88332Examines each additional section of same block = Figure: 24.2 Courtesy National Institute of Environmental Health Sciences— National Institutes of Health.

18 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Urinalysis ( ) Tests on urineTests on urine –Method of test e.g., tablet, reagent, or dipsticke.g., tablet, reagent, or dipstick –Reason for test e.g., pregnancye.g., pregnancy –Constituents being tested for e.g., bilirubin, glucosee.g., bilirubin, glucose(Cont’d…) From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders. Figure: 24.3

19 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Urinalysis (…Cont’d) Equipment usedEquipment used –Automated or nonautomated –With or without microscope Number of tests performedNumber of tests performed

20 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Chemistry ( ) Specific tests on any bodily substancesSpecific tests on any bodily substances –Urine –Blood –Breath –Feces –Sputum (Cont’d…)

21 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Chemistry (…Cont’d) Most chemistry tests are quantitative (specific amount) unless specified qualitativeMost chemistry tests are quantitative (specific amount) unless specified qualitative(Cont’d…)

22 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Chemistry (…Cont’d) Samples from different sources, reported separatelySamples from different sources, reported separately –e.g., blood, feces Samples taken at different times of day reported separatelySamples taken at different times of day reported separately

23 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Hematology and Coagulation ( ) Laboratory procedures on bloodLaboratory procedures on blood –Example Complete blood count (CBC)Complete blood count (CBC) White blood cell count (WBC)White blood cell count (WBC) Codes divided based on method ofCodes divided based on method of –Blood draw –Test being conducted Figure: 24.4 From Clinical Diagnostic Solutions, Inc.: M-Series Hematology Analyzer CAP. (website): page=product_info&cPath=7_44&products_id=97. Accessed July 7, 2009.

24 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Immunology ( ) Identifying immune system conditions caused by antibodies and antigensIdentifying immune system conditions caused by antibodies and antigens –Example: Hepatitis C antibody screening Tissue typing ( )Tissue typing ( ) –Basic assay, screening, typing

25 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Tissue Typing ( ) Compatibility test on tissueCompatibility test on tissue Match donor to recipientMatch donor to recipient Measure/monitor cytotoxic reactionsMeasure/monitor cytotoxic reactions

26 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Transfusion Medicine ( ) Blood bank codesBlood bank codes Tests performed on blood or blood productsTests performed on blood or blood products Do NOT identify supply of blood, butDo NOT identify supply of blood, but –Collection –Processing –Typing Figure: 24.5

27 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Microbiology ( ) Study of microorganismsStudy of microorganisms –Identification of organism –Sensitivities of organism to antibiotics From Mandell GL, Bennett JE, Dolin R, editors: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, ed 6, Philadelphia, 2005, Churchill Livingstone.

28 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Microbiology Caution Many code descriptions similar to those in Immunology ( )Many code descriptions similar to those in Immunology ( ) Difference is technique usedDifference is technique used Figure: 24.6 Courtesy United States Environmental Protection Agency.

29 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Anatomic Pathology ( ) Postmortem examinationsPostmortem examinations –Autopsies Reports only physician serviceReports only physician service Codes divided on extent of exam and type of exam (gross versus gross and microscope)Codes divided on extent of exam and type of exam (gross versus gross and microscope) –Example: Gross exam without central nervous system (88000)Gross exam without central nervous system (88000) Gross and microscopic without central nervous system (88020)Gross and microscopic without central nervous system (88020)

30 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Cytopathology ( ) Identify cellular changesIdentify cellular changes Common laboratory proceduresCommon laboratory procedures –e.g., Pap smear Codes divided onCodes divided on –Type of procedure –Technique used

31 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Cytogenetic Studies ( ) Branch of genetics concerned with cellular abnormalities and pathologic conditionsBranch of genetics concerned with cellular abnormalities and pathologic conditions –Example: Chromosomes From Goldman L, Ausiello D, editors: Cecil Textbook of Medicine, ed 22, Philadelphia, 2004, Saunders.

32 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Surgical Pathology ( ) Evaluation of specimens to determine disease pathologyEvaluation of specimens to determine disease pathology All tissue removed during procedures undergoes pathology evaluationAll tissue removed during procedures undergoes pathology evaluation(Cont’d…)

33 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Surgical Pathology (…Cont’d) Operative report usually coded after pathology report receivedOperative report usually coded after pathology report received Pathology reports usually coded with ORPathology reports usually coded with OR(Cont’d…)

34 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Surgical Pathology (…Cont’d) Unit of measure ( ), specimenUnit of measure ( ), specimen Two anus tags, each examined, x 2Two anus tags, each examined, x 2 One anus tag examined in two different areas of tag, 88304One anus tag examined in two different areas of tag, 88304

35 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Types of Pathologic Examination Microscopic: With microscopeMicroscopic: With microscope Gross: Without microscopeGross: Without microscope –88300, only gross exam code –Others gross and microscopic Courtesy of Cynmar Corporation, Carlinville, IL

36 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Six Levels of Surgical Pathology Based on specimen examinedBased on specimen examined –e.g., Breast, prostate, lung And reason for evaluationAnd reason for evaluation –e.g., Radical procedure for suspected carcinoma (Cont’d…)

37 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Six Levels of Surgical Pathology (…Cont’d) Levels divided on complexity of examinationLevels divided on complexity of examination Example:Example: –88305: Colon, biopsy –88307: Colon, segmental resection, other than for tumor –88309: Colon, total resection

38 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Levels Level ILevel I –Specimen can be accurately diagnosed without microscopic examination Level IILevel II –Gross and microscopic examination performed Levels III, IV, V, and VILevels III, IV, V, and VI –Includes gross and microscopic examination and additional physician work (increasing difficulty) Based upon method of or need for removalBased upon method of or need for removal Same anatomical site can be listed in each levelSame anatomical site can be listed in each level The Gram’s stain. Red blood cells (RBC) and gram-positive cocci. From McPherson RA, Pincus MR: Henry’s Clinical Diagnosis and Management by Laboratory Methods, ed 21, St. Louis, 2007, Saunders.

39 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Not Included In Codes Additional service codes are not included in codes Additional service codes are not included in codes –Example: Special stains (88312) –Additional services reported separately ( )

Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Conclusion CHAPTER 24 PATHOLOGY / LABORATORY