1. Pathology & Laboratory By Alejandra Munoz, CPC, NCICS

2. Types of Pathology and Laboratory 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 Cytogenetic Studies Surgical Pathology Transcutaneous Procedures Other Procedures Reproductive Medicine Procedures

3. Pathology & Laboratory  Codes for laboratory tests only.  Specimen collection coded separately  Example: Venus blood draw reported 36415 (surgery section)

4. Facility Indicators  Allow additional tests without physician written order  Example: Urinalysis positive for bacteria  Built-in indicator for culture

5. Pathology/Lab caution  Usually report second or subsequent tests without -51 (modifier), multiple procedures  Rather report times (x)

6. Organ or Disease-oriented Panels (80047-80076)  Groups of tests often ordered together  Examples:  Basic Metabolic panel  General Health panel  Electrolyte panel

7. Rules of Panels  All tests must have been conducted and be medically necessary  Do not use -52, Reduced Service  Additional tests, over those in panel, reported separately  If all test in panel not performed:  List each test separately  Do not use panel code  Problem oriented scope

8. Drug Testing (80100-80104)  Lists drug screening, drug confirmation, and tissue preparation services  Identifies presence or absence of drug – qualitative analysis  Confirmation conducted to double check results of positive drug test (80102)

9. Drug Testing, Cont…  Chromatography” 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

10. Drug Testing, Cont..  Code the number of procedures, not the number of drugs tested for.  Example:  Two procedures to identify three drugs: 80100 x 2  One procedure to identify three drugs: 80100

11. Therapeutic Drug Assays  Reports presence and amount (quantitative) or absence of a substance  Material examined can be from any source  Drugs listed by Generic 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) – used to monitor therapeutic drug medication adjustment

12. Evocation/Suppression Testing (80400-80440)  Measures stimulating (evocative – calling forth a response) or suppressing agents  Codes report only TC of service  TC= Technical Component

13. Evocation/Suppression Testing  Additional services to report:  Supplies and/or drugs used in testing (99070 and/or HCPCS J codes)  E/M for physician monitoring of testing

14. Consultations (Clinical pathology)  At request of physician  Additional information about specimen  Consultant prepares written report  Levels  Limited: Without review of medical records  Comprehensive: With review of medical record

15. More Consultation codes…  Surgical pathology (88321- 88334)  Used when pathologist either:  Reviews slides, material, or reports  Provides consultation during surgery  Reported on specimen, block, section, cytologic exam

16. Pathology Terminology  Specimen: Sample of tissue of suspect area  Block: Frozen piece of specimen  Section: Slice of frozen block  Example: Pathologist consults during surgical procedure  Examines one block= 88331  Examines each additional section of same block= 88332

17. Urinalysis (81000-81099)  Tests on urine  Method of test  e.g., tablet, or dipstick  Reason for test  e.g., pregnancy  Constituents being tested for  e.g., bilirubin, glucose

18. Urinalysis, cont…  Equipment used  Automated or non automated  With or without a microscope  Number of test performed

19. Chemistry (82000-84999)  Specific tests on any bodily substance  Urine  Blood  Breath  Feces  Most chemistry tests are quantitative (specific amount) unless specified qualitative

20. Chemistry, Cont…  Samples from different sources, reported separately  e.g., blood, feces  Samples taken at different times of days reported separately

21. Molecular pathology Procedures (81200-81406)  81200-81383 are Tier 1 procedures that report molecular assay  More common gene specific procedures  Example: Breast cancer gene-81211  81499-81406 are Tier 2 procedures to report less commonly performed analyses

22. Hematology and Coagulation (85002-85999)  Laboratory procedures on blood  Example:  Complete blood count (CBC)  White blood cell count (WBC)  Codes divided based on method of:  Blood draw  Test being conducted

23. Immunology (86000-86804)  Identifying immune system conditions caused by antibodies and antigens  Example: Hepatitis C antibody screening  Tissue typing  Basic assay, screening, typing

24. Transfusion Medicine (86850- 86999)  Blood bank codes  Test performed on blood or blood products  Do NOT identify supply of blood, but  Collection  Processing  typing

25. Surgical Pathology (88300- 88399)  Evaluation of specimens to determine disease pathology  All tissue removed during procedures undergoes pathology evaluation

26. Types of Pathologic Examination  Microscopic: With microscope  Gross: Without microscope  88300, only gross exam code  Other gross AND microscopic

27. Levels  Level I  Specimen can be diagnosed without microscopic examination  Level II  Gross and microscopic examination performed  Level III, IV, V, VI  Includes gross and microscopic examination and additional physician work  Based upon method of or need for removal  Same anatomic site can be listed in each level

28. Reference:  Buck, C (2010). Step by Step. Elsevier.