1. Week 7 Seminar CPT Pathology & Laboratory Codes (Chapter 17) and Radiology Codes (Chapter 16)

2. Laboratory CPT Codes page 699 Include performance, not collectionInclude performance, not collection Term(s) for puncture of a vein using a needle to draw blood?Term(s) for puncture of a vein using a needle to draw blood? Types of tests?Types of tests? Difference if commercial or Medicare patient?Difference if commercial or Medicare patient? Term for puncture of a artery using a needle to draw blood?Term for puncture of a artery using a needle to draw blood? Types of tests?Types of tests? Coding Tip

3. Professional & Technical Components page 700 PC modifier?PC modifier? Who reports it?Who reports it? For what?For what? How? How? TC modifier?TC modifier? Who reports it?Who reports it? What’s included?What’s included? How?How?

4. Guidelines page 702-704 Services = specimen processingServices = specimen processing Separate or multiple procedures = parametersSeparate or multiple procedures = parameters Subsection Information = notesSubsection Information = notes Unlisted services and procedures = unlistedUnlisted services and procedures = unlisted Special Reports = usageSpecial Reports = usage Modifier -51 = notModifier -51 = not Modifier -91 = addModifier -91 = add

5. Miscellaneous page 705-707 What is a panel?What is a panel? What is an assay?What is an assay? When would we use consultations?When would we use consultations? Laboratory areas of testing:Laboratory areas of testing: UrinalysisUrinalysis ChemistryChemistry ImmunologyImmunology MicrobiologyMicrobiology PathologyPathology Hematology & CoagulationHematology & Coagulation

6. Radiology Pg. 652 What’s in this section?What’s in this section? Suffix termsSuffix terms -graphy-graphy - scopy- scopy -gray or -gy-gray or -gy Professional vs. Technical ComponentsProfessional vs. Technical Components

7. Radiology page 658-676 ModifiersModifiers -52-52 -76-76 Applying E&M codesApplying E&M codes Contrast MaterialsContrast Materials FluoroscopyFluoroscopy CT vs. MRICT vs. MRI Mammogram – Male vs. FemaleMammogram – Male vs. Female

8. Practice #1 Note the patient has Urinary incontinence and the doctor has ordered a UA, Routine The box for “No ABN needed” is checked - why? The test is ordered ASAP. What does that mean? Now code the Dx and Service codes.

9. Practice Answers Practice #1 SERVICE CODE(S): 81003SERVICE CODE(S): 81003 Urinalysis Automated, without microscopy DX CODE(S): 788.30DX CODE(S): 788.30 Urinary incontinence, unspecified (enuresis NOS)

10. Practice #2 Note the patient has Addison’s and the doctor has ordered a hemoglobin and CBC with diff The box for “No ABN needed” is checked -why? The test is ordered ASAP. What does that mean? Now code the Dx and Service codes.

11. Practice Answers Practice #2 SERVICE CODE(S): 85025, 85018SERVICE CODE(S): 85025, 85018 CBC, automated w/DiffCBC, automated w/Diff HgbHgb DX CODE(S): 281.0DX CODE(S): 281.0 Pernicious anemia (Addison’s) What’s excluded?

12. Practice #3 What are the correct codes for this order? Why? A 27-year-old female presents for her initial obstetrical laboratory tests during her first pregnancy, which included: ABO blood typing RhD blood typing Rubella antibody Hemogram with manual WBC and CBC Hepatitis B Qualitative VDRL RBC antibody screen

13. Practice Answers Practice #3 SERVICE CODE(S): 80055SERVICE CODE(S): 80055 OB Panel DX CODE(S): v22.0DX CODE(S): v22.0 Supervision of normal first pregnancy Supervision of normal first pregnancy

14. Radiology Coding Practice page 696 42. Radiation Treatment: How many MeV and where? 43. Diagnostic Ultrasound: What kind of US is this? 44. CT Scan: Type? 45. CT Scan: Type? 46. X-Ray of Shoulder: How many views? 49. MRI of Heart: Contrast? 50. NM Whole Body Bone and Joint Scan: Findings?

15. Radiology Coding Practice Answers page 696 42. Radiation Treatment: How many MeV and where? 4 MeV to Thyroid: 77402 (rad tx, single tx area, single or parallel ports, up to 5 MeV) 43. Diagnostic Ultrasound: What kind of US is this? Male Genital: 76870 (Genitalia US, scrotum and contents) 44. CT Scan: Type? Neck w/Contrast: 70491 (CT neck w/contrast) 45. CT Scan: Type? Lumbar Spine: 72131 (CT LS w/o contrast) 46. X-Ray of Shoulder: How many views? 2 views-AP & Lateral: 73030 (radiology shoulder complete, minimum of 2 views) 49. MRI of Heart: Contrast? No contrast – complete view: 75557 (Cardiac MRI for morphology and function w/o contrast) 50.NM Whole Body Bone and Joint Scan: Findings? Nasal area sphenoid sinus uptake: 78306 (Musculoskeletal, Bone and/or Joint imaging; whole body)

16. Radiology Case Practice LOCATION: Outpatient, Hospital What are the correct codes for this order? PREOPERATIVE DIAGNOSIS: Left ureteral calculus POSTOPERATIVE DIAGNOSIS: Left ureteral calculus PROCEDURE PERFORMED: Left ureteroscopic stone extraction under fluoroscopic control CLINICAL NOTE: The patient is a 50-year-old gentleman with intermittent left renal colic and left distal ureteral stone that has not passed spontaneously. PROCEDURE: The patient was given a general endotracheal anesthesia, prepped, and draped in the lithotomy position. A 21-French cystoscope was passed into the bladder under direct vision. The urethra was normal. The bladder was normal. The prostate was not obstructed. A guide wire was then advanced up to the left ureter beyond the stone under fluoroscopic control. The patient was ureteroscoped without prior ureteral dilation using a 7-French rigid scope. The stone was visualized, grasped within a 0-tip basket, and withdrawn intact. Repeat ureteroscopy showed no evidence of ureteral abrasion or edema. It was decided not to stent the patient. The bladder was drained. The scope was withdrawn. B and O suppository was placed rectally. The patient was transferred to the recovery room in good condition. We will schedule him for renal ultrasound, KUB, and follow-up in 3 months’ time. The stone will be shown to the patient and then sent for analysis. Pathology Report Later Indicated: Benign calculi

17. Radiology Case Practice Answers LOCATION: Outpatient, Hospital DX CODE(S): 592.1 and SERVICE CODE(S): 52352-LT, 76000-26 DX = Calculus of ureter SVS = Cysto w/ureteroscopy with removal of calculus and Fluoro up to 1 hour Let’s define and break down the terms: PROCEDURE PERFORMED: Left ureteroscopic stone extraction under fluoroscopic control CLINICAL NOTE: The patient is a 50-year-old gentleman with intermittent left renal colic and left distal ureteral stone that has not passed spontaneously. PROCEDURE: The patient was given a general endotracheal anesthesia, prepped, and draped in the lithotomy position. A 21-French cystoscope was passed into the bladder under direct vision. The urethra was normal. The bladder was normal. The prostate was not obstructed. A guide wire was then advanced up to the left ureter beyond the stone under fluoroscopic control. The patient was ureteroscoped without prior ureteral dilation using a 7-French rigid scope. The stone was visualized, grasped within a 0-tip basket, and withdrawn intact. Repeat ureteroscopy showed no evidence of ureteral abrasion or edema. It was decided not to stent the patient. The bladder was drained. The scope was withdrawn. B and O suppository was placed rectally. The patient was transferred to the recovery room in good condition. We will schedule him for renal ultrasound, KUB, and follow-up in 3 months’ time. The stone will be shown to the patient and then sent for analysis. Pathology Report Later Indicated: Benign calculi

18. Next Week Last Seminar Next Week Last Seminar Evaluation & Management Codes (Chapter 9) and FINAL EXAM REVIEW