Slide 1 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. CHAPTER 29 PATHOLOGY / LABORATORY

Slide 2 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Types of Pathology and Laboratory Subsections such as: Organ or Disease-Oriented Panels Drug Testing Therapeutic Drug Assays Evocative/Suppression Testing Consultations (Clinical Pathology) Urinalysis Molecular Pathology Chemistry Hematology and Coagulation Immunology Transfusion Medicine Microbiology Anatomic Pathology Cytopathology Cytogenetic Studies Surgical Pathology Transcutaneous Procedures Other Procedures Reproductive Medicine Procedures

Slide 3 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Pathology and Laboratory Codes for _________ test only ________________ coded separately –Example: Venous blood draw reported _____ (Surgery section) Medicare fee schedule each year identifies those lab tests associated with a physician component (-26) From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders. laboratory Specimen collection Figure: 29.1

Slide 4 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Facility Indicators Allow additional ____ without physician written order –Example: Urinalysis positive for bacteria –Built-in indicator for culture tests

Slide 5 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Pathology/Laboratory Caution Usually report second or subsequent tests without -51, multiple procedures Rather report times (x)

Slide 6 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Organ or Disease-Oriented Panels ( ) Groups of tests often ordered together –Example: Basic Metabolic Panel General Health Panel Electrolyte Panel

Slide 7 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Rules of Panels All tests must have been conducted & be medically necessary Do not use ___, Reduced Service Additional tests, over those in panel, reported ________ If all tests in panel not performed –List each test separately –Do not use panel code Problem oriented in scope -52 separately

Slide 8 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Drug Testing ( ) Lists drug screening, drug confirmation, and tissue preparation services Identifies presence or absence of drug– ________ analysis Confirmation conducted to double check results of positive drug test (_____) (Cont’d…) qualitative 80102

Slide 9 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Drug Testing (…Cont’d) ______________ : procedure in which multiple drugs identified –Some machines identify all drugs present in one procedure –Others require two or more procedures to identify two or more drugs (Cont’d…) Chromatography

Slide 10 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Drug Testing (…Cont’d) Code the number of _________, not the number of drugs tested for –Example: Two procedures to identify three drugs = × 2 One procedure to identify three drugs = (Cont’d…) procedures

Slide 11 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Drug Testing (…Cont’d) Does not identify ______ of drug present –Only presence or absence Quantitative analysis tests for specific amount of analyte present amount

Slide 12 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Therapeutic Drug Assays ( ) Reports presence and ______ (quantitative) or absence of a substance Material examined can be from any _____ Drugs listed by ______ names –Example: Amitriptyline generic name for brand name Elavil –PDR a must for coding drug testing Measures peaks (after drug given at intervals) and troughs (before drug given next dose)—used to monitor therapeutic drug for medication adjustment amount source generic

Slide 13 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Evocation/Suppression Testing ( ) Measures stimulating (evocative—calling forth a response) or suppressing agents Codes report only TC of service –TC = ____________________ Technical Component (Cont’d…)

Slide 14 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Evocation/Suppression Testing (…Cont’d) Additional services to report: –Supplies and/or drugs used in testing (99070 and/or HCPCS J codes) E/M for physician monitoring of testing

Slide 15 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Consultations (Clinical Pathology) (80500, _____) At request of physician –Additional information about specimen –Consultant prepares ______ report Levels –______: Without review of medical record –____________: With review of medical record written Limited Comprehensive

Slide 16 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. More Consultation Codes Surgical Pathology, Used when pathologist either –Reviews slides, material, or reports –Provides consultation during surgery Reported on specimen, block, section, cytologic exam

Slide 17 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Pathology Terminology ________: Sample of tissue of suspect area _____ : Frozen piece of specimen ______: Slice of frozen block –Example: Pathologist consults during surgical procedure Examines ___ block = Examines _____________ section of same block = Specimen Block Section one each additional Figure: 29.2 Courtesy National Institute of Environmental Health Sciences— National Institutes of Health.

Slide 18 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Urinalysis ( ) Tests on urine –Method of test e.g., tablet, reagent, or dipstick –Reason for test e.g., pregnancy –Constituents being tested for e.g., bilirubin, glucose (Cont’d…) From Proctor DB, Adams AP: Kinn's The Medical Assistant: An Applied Learning Approach, ed 12, St. Louis, 2014, Saunders. Figure: 29.3

Slide 19 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Urinalysis (…Cont’d) Equipment used –Automated or ___________ –With or without microscope Number of tests performed nonautomated

Slide 20 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Chemistry Specific tests on any bodily substances –Urine –Blood Most chemistry tests are _________ (specific amount) unless specified qualitative (Cont’d…) – Breath – Feces quantitative

Slide 21 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Chemistry (…Cont’d) Samples from different ______, reported separately –e.g., blood, feces Samples taken at different ____ of day reported separately sources times

Slide 22 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Molecular Pathology (81161, ) 81161, are Tier 1 procedures that report molecular assay –More common gene specific procedures –Example, breast cancer gene–81211 (BRCA1 or BRCA2) are Tier 2 procedures to report less commonly performed analyses reports unlisted molecular pathology procedures

Slide 23 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Hematology and Coagulation ( ) Laboratory procedures on blood –Example __________________ (CBC) __________________ (WBC) Codes divided based on method of –Blood draw –Test being conducted Complete blood count White blood cell count Figure: 29.4 From Clinical Diagnostic Solutions, Inc.: M-Series Hematology Analyzer CAP. (website): page=product_info&cPath=7_44&products_id=97. Accessed February 9, 2013.

Slide 24 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Immunology ( ) Identifying immune system conditions caused by antibodies and antigens –Example: Hepatitis C antibody screening Tissue typing (86805-_____) –Basic assay, screening, typing 86849

Slide 25 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Tissue Typing ( ) Compatibility test on tissue Match donor to recipient Measure/monitor cytotoxic reactions

Slide 26 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Transfusion Medicine ( ) Blood bank codes Tests performed on blood or blood products Do NOT identify supply of blood, but –Collection –Processing –_____ Typing Figure: 29.5

Slide 27 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Microbiology ( ) Study of microorganisms –Identification of organism –_________ of organism to antibiotics From Mandell GL, Bennett JE, Dolin R: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, ed 7, Philadelphia, 2010, Churchill Livingstone. Sensitivities

Slide 28 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Microbiology Caution Many code descriptions similar to those in Immunology ( ) Difference is ________ used technique Figure: 29.6 Courtesy United States Environmental Protection Agency.

Slide 29 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Anatomic Pathology ( ) Postmortem examinations –Autopsies Reports only ________ service Codes divided on _____ of exam and ____ of exam (gross versus gross and microscope) –Example: Gross exam without central nervous system (88000) Gross and microscopic without central nervous system (88020) physician type extent

Slide 30 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Cytopathology ( ) Identify cellular changes Common laboratory procedures –e.g., Pap smear Codes divided on –____ of procedure –________ used Type Technique

Slide 31 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Cytogenetic Studies ( ) Branch of genetics concerned with ______ abnormalities and pathologic conditions –Example: Chromosomes From Goldman L, Schafer AI, editors: Goldman's Cecil Medicine, ed 24, Philadelphia, 2012, Saunders. cellular

Slide 32 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Surgical Pathology ( ) Evaluation of specimens to determine disease pathology All tissue removed during procedures undergoes pathology evaluation (Cont’d…)

Slide 33 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Surgical Pathology (…Cont’d) Operative report usually coded ____ pathology report received Pathology reports usually coded with OR after (Cont’d…)

Slide 34 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Surgical Pathology (…Cont’d) Unit of measure ( ), specimen Two anus tags, each examined, x _ One anus tag examined in two different areas of tag,

Slide 35 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Types of Pathologic Examination Microscopic: With microscope Gross: Without microscope –_____, only gross exam code –Others gross and ___________ Courtesy of Cynmar Corporation, Carlinville, IL microscopic

Slide 36 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Six Levels of Surgical Pathology Based on ________ examined –e.g., Breast, prostate, lung And reason for evaluation –e.g., Radical procedure for suspected carcinoma specimen (Cont’d…)

Slide 37 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Six Levels of Surgical Pathology (…Cont’d) Levels divided on ________ of examination Example: –88305: Colon, biopsy –88307: Colon, segmental resection, other than for tumor –88309: Colon, total resection complexity

Slide 38 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Levels Level I –Specimen can be diagnosed without microscopic examination Level II –Gross and microscopic examination performed Levels III, IV, V, and VI –Includes gross and microscopic examination and additional physician work (increasing difficulty) Based upon method of or need for removal Same anatomical site can be listed in each level The Gram’s stain. Red blood cells (RBC) and gram-positive cocci. From McPherson RA, Pincus MR: Henry’s Clinical Diagnosis and Management by Laboratory Methods, ed 22, St. Louis, 2011, Saunders.

Slide 39 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Not Included In Codes Additional service codes are not included in codes –Example: Special stains (88312) –Additional services reported separately

Slide 40 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Conclusion CHAPTER 29 PATHOLOGY / LABORATORY