Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 CHAPTER 29 PATHOLOGY / LABORATORY

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 2 Types of Pathology and Laboratory Subsections such as: 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 Cytopathology Cytogenetic Studies Surgical Pathology Transcutaneous Procedures Other Procedures Reproductive Medicine Procedures

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 3 Pathology and Laboratory Codes for laboratory test only Specimen 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) From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders. Figure: 29.1

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 4 Facility Indicators Allow additional tests without physician written order –Example: Urinalysis positive for bacteria –Built-in indicator for culture

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 5 Pathology/Laboratory Caution Usually report second or subsequent tests without -51, multiple procedures Rather report times (x)

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 6 Organ or Disease-Oriented Panels ( ) Groups of tests often ordered together –Example: Basic Metabolic Panel General Health Panel Electrolyte Panel

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 7 Rules of Panels All tests must have been conducted & be medically necessary Do not use -52, Reduced Service Additional tests, over those in panel, reported separately If all tests in panel not performed –List each test separately –Do not use panel code Problem oriented in scope

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 8 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) (Cont’d…)

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 9 Drug Testing (…Cont’d) 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 (Cont’d…)

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 10 Drug Testing (…Cont’d) Code the number of procedures, not the number of drugs tested for –Example: Two procedures to identify three drugs = × 2 One procedure to identify three drugs = (Cont’d…)

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 11 Drug Testing (…Cont’d) Does not identify amount of drug present –Only presence or absence Quantitative analysis tests for specific amount of analyte present

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 12 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 next dose)—used to monitor therapeutic drug for medication adjustment

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 13 Evocation/Suppression Testing ( ) Measures stimulating (evocative—calling forth a response) or suppressing agents Codes report only TC of service TC = Technical Component (Cont’d…)

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 14 Evocation/Suppression Testing (…Cont’d) Additional services to report: –Supplies and/or drugs used in testing (99070 and/or HCPCS J codes) E/M for physician monitoring of testing

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 15 Consultations (Clinical Pathology) (80500, 80502) At request of physician –Additional information about specimen –Consultant prepares written report Levels –Limited: Without review of medical record –Comprehensive: With review of medical record

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 16 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

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 17 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 = Figure: 29.2 Courtesy National Institute of Environmental Health Sciences— National Institutes of Health.

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 18 Urinalysis ( ) Tests on urine –Method of test e.g., tablet, reagent, or dipstick –Reason for test e.g., pregnancy –Constituents being tested for e.g., bilirubin, glucose (Cont’d…) From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders. Figure: 29.3

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 19 Urinalysis (…Cont’d) Equipment used –Automated or nonautomated –With or without microscope Number of tests performed

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 20 Chemistry Specific tests on any bodily substances –Urine –Blood Most chemistry tests are quantitative (specific amount) unless specified qualitative (Cont’d…) – Breath – Feces

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 21 Chemistry (…Cont’d) Samples from different sources, reported separately –e.g., blood, feces Samples taken at different times of day reported separately

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 22 Molecular Pathology Procedures ( ) are Tier 1 procedures that report molecular assay –More common gene specific procedures –Example, breast cancer gene–81211 (BRCA1 or BRCA2) are Tier 2 procedures to report less commonly performed analyses

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 23 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 Figure: 29.4 From Clinical Diagnostic Solutions, Inc.: M-Series Hematology Analyzer CAP. (website): page=product_info&cPath=7_44&products_id=97. Accessed January 20, 2011.

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 24 Immunology ( ) Identifying immune system conditions caused by antibodies and antigens –Example: Hepatitis C antibody screening Tissue typing ( ) –Basic assay, screening, typing

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 25 Tissue Typing ( ) Compatibility test on tissue Match donor to recipient Measure/monitor cytotoxic reactions

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 26 Transfusion Medicine ( ) Blood bank codes Tests performed on blood or blood products Do NOT identify supply of blood, but –Collection –Processing –Typing Figure: 29.5

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 27 Microbiology ( ) Study 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.

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 28 Microbiology Caution Many code descriptions similar to those in Immunology ( ) Difference is technique used Figure: 29.6 Courtesy United States Environmental Protection Agency.

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 29 Anatomic Pathology ( ) Postmortem examinations –Autopsies Reports only physician service Codes divided on extent of exam and type of exam (gross versus gross and microscope) –Example: Gross exam without central nervous system (88000) Gross and microscopic without central nervous system (88020)

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 30 Cytopathology ( ) Identify cellular changes Common laboratory procedures –e.g., Pap smear Codes divided on –Type of procedure –Technique used

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 31 Cytogenetic Studies ( ) Branch 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.

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 32 Surgical Pathology ( ) Evaluation of specimens to determine disease pathology All tissue removed during procedures undergoes pathology evaluation (Cont’d…)

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 33 Surgical Pathology (…Cont’d) Operative report usually coded after pathology report received Pathology reports usually coded with OR (Cont’d…)

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 34 Surgical Pathology (…Cont’d) Unit of measure ( ), specimen Two anus tags, each examined, x 2 One anus tag examined in two different areas of tag, 88304

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 35 Types of Pathologic Examination Microscopic: With microscope Gross: Without microscope –88300, only gross exam code –Others gross and microscopic Courtesy of Cynmar Corporation, Carlinville, IL

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 36 Six Levels of Surgical Pathology Based on specimen examined –e.g., Breast, prostate, lung And reason for evaluation –e.g., Radical procedure for suspected carcinoma (Cont’d…)

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 37 Six Levels of Surgical Pathology (…Cont’d) Levels divided on complexity of examination Example: –88305: Colon, biopsy –88307: Colon, segmental resection, other than for tumor –88309: Colon, total resection

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 38 Levels Level I –Specimen can be diagnosed without microscopic examination Level II –Gross and microscopic examination performed Levels III, IV, V, and VI –Includes gross and microscopic examination and additional physician work (increasing difficulty) Based upon method of or need for removal Same 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.

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 39 Not Included In Codes Additional service codes are not included in codes –Example: Special stains (88312) –Additional services reported separately

Copyright © 2012, 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 40 Conclusion CHAPTER 29 PATHOLOGY / LABORATORY