1. Unit 8 Presentation Chapter 17
CPT Pathology and Laboratory
Shatondra Surulere, MBA, RHIA, CCs

2. Overview of Pathology and Laboratory Section
CPT Pathology and Laboratory codes describe services performed on specimens (such as body fluids, tissue or cytological specimens)
The services are used to evaluate, prevent, diagnose, or treat a disease.

3. Laboratory Examinations
Biophysical
Chemical
Cytological
Hematological
Immunohematological
Microbiological
Pathological
Serological
Pap Smear
Question what type of test would be done for a pap smear?--Cytological 3

4. Specimen Tissue submitted for laboratory or pathological evaluation
Blood
Urine
Tissue from an organ
Example is an appendix that is removed and sent to pathology or a wound culture of an infected decubitus ulcer of the sacrum.

5. Specimen Collection
Specimen collection is not included in the code for the performance of the test.
Venipunctures, arterial punctures, lumbar punctures, or collection performed by staff are separate codes.
There is no code for urine collection by the patient.
When nurse, doctor, or phlebotomist collects specimen. 5

6. Laboratory and Pathological Service Codes
Most clinical laboratory service codes include a technical component.
Some services include both a technical and professional component. 6

7. 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 7

8. Clinical Pathology Professional services include:
Directing and evaluating quality assurance and control procedures
Supervising laboratory technicians
Recommending follow-up diagnostic tests 8

9. 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)
???? Special stains; Group I for microorganisms, including interpretation and report, each
If the facility was only reporting their technical component of this procedure they would code
88312-TC 9

10. 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 10

11. Coding Tip
When reporting CLIA-waived services to Medicare or Medicaid, add HCPCS level II modifier -QW to pathology and laboratory codes. 11

12. Pathology and Laboratory Sections
Organization
According to procedure performed
Procedures listed alphabetically within each subsection
Review patient record documentation, code descriptions, and instructional notes 12

13. 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 13

14. 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 14

15. Special Report May include: Complexity of symptoms Final diagnosis
Pertinent physical findings
Diagnostic and therapeutic procedures
Concurrent problems
Follow-up care 15

16. Coding Tip
Modifier -90 [reference (outside) laboratory] is reported to indicate that an outside laboratory performed the service. 16

17. Clinical Laboratory Improvement Act (CLIA)
Physician office labs must obtain certification to:
Perform certain pathology and laboratory tests
Submit claims to Medicare and Medicaid
Chemstrip Automated Urine Analyzer 17

18. 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 18

19. Subsections Organ or disease-oriented panels Drug testing
Therapeutic drug assays
Evocative/Suppression testing
Consultations (clinical pathology)
Urinalysis 19

20. Subsections Chemistry Hematology and coagulation Molecular diagnostics
Transfusion medicine
Microbiology
Anatomic pathology 20

21. Subsections Cytopathology Cytogenetic studies Surgical pathology
Transcutaneous procedures
Other procedures
Reproductive medicine procedures 21

22. Organ/Disease-Oriented Panels
Organ or disease oriented panels are report for a defined group of tests, administered for a certain purpose.
Comprehensive metabolic panel (CMP)
When one or several tests are performed, do not report panel code
Report codes for each, individual test 22

23. Questions 23