1. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 10-1 Chapter 10 Pathology and Laboratory Coding

2. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives 10.1 Translate the guidelines for accurately coding clinical chemistry procedures. 10.2 Apply the in-section guidelines regarding molecular diagnostic testing. 10.3 Correctly apply guidelines for reporting hematology and coagulation tests. 10-2

3. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives (cont.) 10.4 Discern cytopathology and cytogenetic studies. 10.5 Interpret the guidelines for accurately coding surgical pathology. 10.6 Determine how and when to use modifiers. 10-3

4. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms Cytology Etiology Gross examination Laboratory Microscopic examination Pathology 10-4

5. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Qualitative Quantitative Specimen Surgical pathology 10-5

6. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pathology and Procedure Coding Pathology and lab testing –Help to detect the presence of disease early –Rule out or confirm conditions –Predict the occurrence of disease in the future 10-6

7. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pathology and Procedure Coding Specimens collected from different sources –Blood –Urine –Bodily fluids –Tissue 1-7

8. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Panels Panel codes may be reported only when –All tests listed in the panel, as identified by CPT, have been performed If fewer tests were done, code each test separately. Do not report the panel code. Modifier 52 Reduced Services cannot be appended to a Panel Code. 10-8

9. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Testing Methodology and Sources Quantitative means a count or measure of something Qualitative means determining the quality or character 10-9

10. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Clinical Chemistry Blood glucose –Identifies hyperglycemia or hypoglycemia Electrolytes –Used to diagnose metabolic or kidney disorders Enzymes –Detect the release of enzymes into bloodstream by damaged or diseased organ 10-10

11. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Clinical Chemistry (cont.) Hormones –Existing in too high or too low quantities Lipids –Used to identify heart disease or liver disease Metabolic substances –Identify the presence of gout Proteins –Detect malnutrition or infections 10-11

12. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Molecular Diagnostics Used to investigate –Infectious disease –Oncology –Hematology –Neurology –Genetics 10-12

13. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Hematology and Coagulation The study of blood and its disorders –CBC Complete blood cells –WBC White blood cells –RBC Red blood cells –Platelet count –HCT Hematocrit –HB Hemoglobin –Differential blood count –PT Prothrombin time 10-13

14. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Immunology –Tests identify autoimmune diseases and immunodeficiency disorders –Tests also evaluate compatibility of tissues for transplantation 10-14

15. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Microbiology –Studies bacteria, fungi, parasites, and viruses that may invade the body –Specimens used for testing include: Blood Urine Sputum Feces Cerebrospinal fluid (CSF) –Tests may be Presumptive identification Definitive identification 10-15

16. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cytopathology and Cytogenetic Studies Cytology is the study of one cell at a time Used to discover abnormal cells in tissue or bodily fluids Used to detect cancer cells, infectious organisms, and screen for fetal abnormalities 10-16

17. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cytopathology and Cytogenetic Studies (cont.) Specimens obtained by –Fine-needle aspirations Eg. Amniocentesis –Scraping of tissues Eg. Pap smears –Collection of bodily fluids Eg. Sputum, seminal fluid, or sperm 10-17

18. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Surgical Pathology Examination of excised tissue specimen Tests can be run while patient is still in the operating room Then, if necessary, a therapeutic procedure can immediately follow a diagnostic procedure, based on pathological results Saves money for patient, facility, and the third-party payer 10-18

19. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Surgical Pathology (cont.) Codes 88300–88309 –Six levels of surgical pathologic testing –Gross examination –Microscopic examination 10-19

20. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pathologic Testing on Bone Marrow –Diagnostic tool –Assesses a current diagnosis of thrombocytopenia, anemia, or leukopenia –Measures quantities of stored iron and marrow cellularity –Determines neoplasm, infection, fibrosis, or other infiltrative bone disease –Enables staging of lymphoma and/or other malignant neoplasms 10-20

21. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pathologic Testing on Bone Marrow –Specimen is sent to laboratory for analysis –Investigates hematopoiesis (process of forming blood cells) which occurs in the bone marrow 10-21

22. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Modifiers for Laboratory Coding - 90 Reference (outside) laboratory - 91 Repeat clinical diagnostic laboratory test - 92 Alternative laboratory platform testing 10-22

23. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Summary Pathology and laboratory tests provide health care professionals with definitive evidence of the condition that may be interfering with a patient’s good health. Lab tests are an invaluable part of the healthcare toolbox and must be reimbursed for accurately. 10-23