The Pathology and Laboratory section of the CPT manual is formatted according to what?
type of tests performed
True or False: specimen collection is bundled into most pathology/laboratory codes.
False: specimen collection is reported separately.
Can modifier -51 be used with any pathology/laboratory codes?
No. Always list the procedures multiple times. Append modifier -91 (repeat clinical diagnostic test) as appropriate.
established by the facility to allow additional labwork to be performed without written orders from physician. eg: urinalysis positive for bacteria is an indicator for urine culture.
If a patient gets most but not all of the tests listed for a panel, can you code the panel with modifier -52?
No. If exact panel is not performed, code different panel or code each test separately.
If a patient gets two panels and one or more tests is listed under both panels, how is this coded?
Do not code both panels. Code the more extensive panel. Code remaining tests separately.
If code 80102 is used to report testing for presence of both alcohol and cocaine, how is this coded?
Report code twice. Append modifier -91 (repeat clinic diagnostic test) to second code.
Evocative/ Suppression Testing
measures the effect of stimulating (evocative) or suppressive agents of chemical components on body
What additional services are often reported with evocative/suppression testing?
1. supplies/drugs (99070 or HCPCS code)
2. physician administration (96365-96379)
3. physician monitoring (E/M)
4. prolonged physician care codes
"comprehensive" clinical pathology consultation
clinical pathologist reviews test and medical record
clinical pathology consultation
specialist reviews, interprets, and prepares written report on findings at request of attending physician
To correctly code urinalysis, you need to know what 5 variables?
1. method of test
2. reason of test
3. constituents being tested for
4. equipment used
5. number of tests done
Urinalysis codes are for ________ tests performed on urine. Chemistry codes are for ________ tests performed on material from any source.
synonymous with constitutional, often used in reference to the genetic code that is present at birth
What is the difference between Tier 1 and Tier 2 Molecular Pathology procedures?
Tier 1 codes are more commonly performed (eg breast cancer gene screening).
Codes in the Hematology/Coagulation subsection are organized according to what two variables?
method of blood draw and specific test being conducted
When using microbiology codes, what modifier is used for multiple specimens or sites?
-59 (distinct procedural service)
There are many similar codes in the microbiology and immunology subsections- what differentiates them?
branch of genetics concerned with cellular abnormalities and pathologic conditions, eg chromosome abnormalities
There are ________ levels of surgical pathology
six, based on specimen examined and reason for evaluation
Level II pathology
tissues usually considered normal tissue removed for reason other than disease (eg foreskin)
Level III pathology
specimens with low probability of disease/malignancy (eg gallbladder removed for inflammation)
Level IV pathology
higher probability of malignancy/decision making for disease pathology (eg uterus removed d/t prolapse)
Level V pathology
more complex pathology evaluations (eg uterus removed for reasons other than prolapse or neoplasm)
Level VI pathology
examination of neoplastic tissue or very involved specimens (eg total resection of colon)
How do you determine the diagnosis code for labwork?
Code the sign or symptom indicating the reason the test was ordered.
If a more specific diagnosis is confirmed by testing, how is the test ICD-9 coded?
Code for the test result rather than the indications for the test.