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CPT Pathology and Laboratory

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Presentation on theme: "CPT Pathology and Laboratory"— Presentation transcript:

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.


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