1. CPT Pathology and Laboratory
Chapter 17
CPT Pathology and Laboratory

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

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

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

5. Dipstick for Routine Urinalysis
Delmar/Cengage Learning

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

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

8. Performing a Pap Smear
Delmar/Cengage Learning

9. Tissue Biopsy
Delmar/Cengage Learning

10. 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

11. Laboratory Examinations
Biophysical
Chemical
Cytological
Hematological
Immunohematological
(continued)

12. Laboratory Examinations
Microbiological
Pathological
Serological

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

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

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

16. Urine Collection Containers
Delmar/Cengage Learning

17. 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

18. 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)

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

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

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

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

23. 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

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

25. 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

26. 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)

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

28. 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

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