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

5. 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

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

7. Laboratory Examinations
Microbiological
Pathological
Serological

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

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

10. 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.

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

12. 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.

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

14. 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.

15. 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 ___________________.

16. 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

17. 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.

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

19. 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)

20. 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.

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

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

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

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

25. 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 _____________.

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

27. 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

28. 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

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

30. 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 )
To determine whether one or two codes are reported.
Code is reported _________ (once/twice).

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

32. 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)

33. 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.

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

35. 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

36. 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.