Today we're going to work on Chapter 6
Pathology and Laboratory
in the CPT code book. As with many
of our CPT chapters, you will use the
Index when you're looking up codes. You
can either look up the specific name of
the test, such as a urinalysis, the
evocative suppression test, fertility
test, for examples; specific substance or
specimen or sample that you are
measuring like glucose or CPK, which is
an enzyme, cyanide; your specimen would be from the bone marrow,
from the nasal smear or
you can look up the specific method you
used such as culture, fine needle
aspiration and microbiology. So different
ways that you can find the CPT codes.
It's important when you're looking at labs
that you also look at billing
processes. In hospital billing, the
chargemaster assigns those codes and
charges automatically for any procedure
that you have done. It's important you
know what they are and how to assign
codes but in a hospital, no one is going
to sit there and code a lab. It is going
to be in the software that the hospital is
using. In physician billing, the coder has
to determine if the physician performs
a complete procedure or only a
component of it. If you look at the
components of a procedure, someone has to
write the order, someone has to obtain
the specimen, handle the specimen, perform
the actual test, and analyze and
interpret the results. Depending upon
how the facility is handling labs, one or
several people could be involved in this
process. In addition there are payer
guidelines that have to be followed for
reimbursement.The insurance
company might say they will pay for the
lab for this, this and this (usually, diagnoses) but not for this,
so there's definitely always payer
guidelines that have to be considered
anytime you're looking at reimbursement
of lab and pathology.
As you are reading these code descriptions, you will find
quantitative and qualitative studies as
part of the description. A qualitative
screening is when you're just detecting
the presence of something an analyte,
constituent or condition and a
quantitative study is when you are
finding out how much of that analyte is
in a specimen. So qualitative is the
"presence of"; quantitative is "how much".
There are certain modifiers that you
will use when you are coding in the
pathology and lab section. They are
listed here as well as in your textbook
as well as on the inside cover of your
CPT code book. You see I have in the
far column on the right hand side who
would be using those codes. For example,
modifiers 22, 26 and 32- the first
three- would be reported by the physician
but modifier 52 for reduced
services could be reported by the
physician or the hospital and if you're
looking at the modifiers on the inside
cover of your CPT code book the far left
column is for modifiers for the
physician. I have "MD" written in big
letters at the top of that column in my
book. The column of modifiers on the
right hand side of the inside cover of your
CPT code book, those are modifiers that are
used for the hospital. As you continue
down this table, you see modifier 53 is used
by the physician, but (modifier) 59 can be used by
the physician or the hospital. Modifier 90 is used
by the physician but (modifier) 91 can be used by
the physician and the hospital.
Modifier 92, alternative lab platform would be used
by the physician. I've not used modifier
92 so I'm not really clear about when
that would be used but for testing
purposes, it is always important that you
know what your modifiers are.
Remember when you were sitting for a
coding exam, you have your code books in
front of you. if you're sitting for a CCS,
CCA, CPC, different coding exams. For the
RHIT exam, you do not have your code book
sitting in front of you. What they have
done is reproduce the answer selections
as though you are looking at your
codebook. We will try to look at some
examples of that through the semester.
Laboratories are also indexed by the organ or
the disease that they are directed toward.
These are performed more commonly for
specific diseases like hepatitis or
arthritis or specific organs like the
thyroid function or the hepatic function.
The hepatic is your liver function. All the
tests listed in a panel must be
performed for that code to be reported
and if additional tests are performed that
are not part of that panel, those codes
must be reported. When some but not
all of the tests in a panel are not
performed, the individual CPT codes
should be reported. If you want to
look for a list of the panels that are
indexed you would look under the main
term "Organs". Here's an example of an
incomplete panel. This is not in your
textbook. A physician orders part of a
hepatic function panel. The tests
that he had ordered are serum albumin, a
total bilirubin, a direct bilirubin, SGPT,
and SGOT. What is the correct CPT code
assignment?
If the entire panel were done, you would
look under "Blood test, panels. hepatic
function" and 80076 but because we know that
the physician only ordered part of the
hepatic function panel, you would code
those individual tests. I found them by
looking at "Pathology and lab" as my main
term, chemistry and then the individual
tests. The albumin, total bilirubin, direct
bilirubin. SGPT and SGOT. I suggest if
you don't know what those (acronyms) stand for, that
somewhere in your code book, you would
write what that acronym stands for.
A drug assay can be
therapeutic drug assay, a drug assay that
is presumptive or definitive, the
chemistry and your codes that you assign
are based on the purpose and type of
patient results obtained.
Evocative/suppression testing is when the
physician determines a baseline, then
give an agent and then notes what that
effect had on the body. The description
for each panel identifies the type of
test included in that panel and the
number of times a specific test must be
performed. For example, in dexamethasone
suppression within 48 hours this panel
will include measurement of free cortisol
in the urine, twice; measurement of
cortisol, twice; and the volume measurement
for timed collection, twice. So it's very
detailed as to what has to happen in
order for that test to be completed.
Surgical pathology is the unit of
service known as the "specimen" that is
taken during surgery and submitted for
individual and separate attention. The
surgical pathology codes are
differentiated by six levels and when
two or more specimens are obtained on one
patient, separate codes identifying the
appropriate level for each, should be
reported. So you may see a code reported
twice, if two different specimens were
submitted. For codes 88300 through 88309
include the acquisition of the
specimen, the examination and the
reporting of the specimen. Here's an example of a
surgical pathology that's not in the
textbook, "gross and microscopic
examination of a kidney biopsy". You look
under "Pathology and lab, surgical pathology,
Gross and Micro exam" and you get a range (of codes)
there and when you go and look at that
range, you find the specimen that you're
looking at within several options under
each of those codes. A kidney biopsy is
found under Level 4 CPT code 88305.
Just for a note, the gross examination is
when you are looking at the specimen
without the aid of a microscope and with a
microscopic exam, you are using the
scope. Look at your first question in the
review, #2, Therapeutic drug
testing for lithium. You would use
"therapeutic drug assay" as your main term,
"lithium" as your sub term, giving you an
80178. #4 is a confirmatory
test for HTLV-II antibody and your main
term is "antibody". HTLV-II is your sub
term. #6- the gross and
microscopic autopsy including the brain
for 72 year old male. When you look under
"Autopsy, gross and micro exam" it gives
you a range of codes. Code 88025
includes the brain as part of the
description. As with all of our CPT codes,
you're always going to be reading all
the descriptions found within that range
to help you determine the best code.
#8 is an HAI test.
You see here how you would find that
code. HAI is hemagglutination inhibition test.
#10 -serum nickel testing to
detect potential toxic exposure.
"Pathology and lab" would be your main term, then
Chemistry, nickel or you could just look
up "nickel" and also find the same code.
#12-An antibody test for Herpes simplex type I, looking
under the main term "herpes simplex",
antibody and you look at this range of
codes, read your code description and
86695 identifies herpes simplex type 1.
#14- Automated urinalysis by
dipstick, without microscopy. There's your
code right there. Urinalysis is your
main term, automated is your sub term.
When you look at these two codes, one is
without microscopy;one is with
microscopy. We select the code
"without" microscopy 81003.
Here's an example not in the CPT
textbook. There's a good chance you're
going to see this on an exam. A consultation
was written for Dr. Sperry, Clinical
Pathologist, to address test results and
imaging studies to assist Dr. Henry,
attending physician with a difficult
diagnostic problem. Dr. Sperry completed
a review of the patient's history and
medical records and submitted his
consultation report to the attending
physician. Your main term would either be
under "Pathology and lab, clinical
consultation" or under "Consultation" as
your main term, clinical pathology. When
you read these code descriptions, you
find 80502 is when the (consulting) physician,
consulting physician has completed a
review of a patient's history and
medical records. That's all I have for pathology
and lab. If there are any questions about this
chapter, please post them in the
discussion board in our course and I
will try to answer.
I hope you have a good day.