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CHAPTER 25

CHAPTER 25. PATHOLOGY / LABORATORY. Types of Pathology and Laboratory. Subsections such as: Organ or Disease-Oriented Panels Drug Assay Therapeutic Drug Assays Evocative/Suppression Testing Consultations (Clinical Pathology) Urinalysis Molecular Pathology Chemistry

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CHAPTER 25

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  1. CHAPTER 25 PATHOLOGY / LABORATORY

  2. Types of Pathology and Laboratory Subsections such as: Organ or Disease-Oriented Panels Drug Assay 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

  3. Pathology and Laboratory Codes for laboratory test only Specimen collectioncoded separately Example: Venous blood draw reported 36415 (Surgery section) Medicare fee schedule each year identifies those lab tests associated with a physician component (modifier -26) Figure 25.1 From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders.

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

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

  6. Organ or Disease-Oriented Panels (80047-80081) Groups of tests often ordered together Example: 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 modifier -52, Reduced Service Additional tests, over those in panel, reported separately If all tests in panel not performed List each test separately Do not use panel code Problem oriented in scope

  8. Presumptive Drug Class Screening (80305-80307) (1 of 3) Divided by methods Three different method categories include: Optical observation (80305) Instrument assisted (80306) Instrument chemical analyzers (80307) Identifies presence or absence of drug

  9. Presumptive Drug Class Screening (80305-80307) (2 of 3) Chromatography: procedure in which single or multiple drugs identified Reports chromatography procedure(s) Screening(s) is presumptive Report 80307

  10. Presumptive Drug Class Screening (80305-80307) (3 of 3) Does not identify amount of drug present Only presence or absence

  11. Therapeutic Drug Assays (80150-80299) 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 assays Measures peaks (after drug given at intervals) and troughs (before drug given next dose)—used to monitor therapeutic drug for medication adjustment

  12. Evocation/Suppression Testing (80400-80439) (1 of 2) Measures stimulating (evocative—calling forth a response) or suppressing agents Codes report only TC of service Modifier -TC = Technical Component

  13. Evocation/Suppression Testing(80400-80439) (2 of 2) 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) (80500, 80502) At request of physician Additional information about specimen Consultant prepares written report Levels Limited: Without review of medical record 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 Figure 25.2 Courtesy National Institute of Environmental Health Sciences—National Institutes of Health.

  17. Urinalysis (81000-81099) (1 of 2) 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 Figure 25.3 From Proctor DB, Adams AP: Kinn's The Medical Assistant: An Applied Learning Approach, ed 12, St. Louis, 2014, Saunders.

  18. Urinalysis (81000-81099) (2 of 2) Equipment used Automated or nonautomated With or without microscope Number of tests performed

  19. Chemistry (82009-84999) (1 of 2) Specific tests on any bodily substances Urine Blood Most chemistry tests are quantitative (specific amount) unless specified qualitative • Breath • Feces

  20. Chemistry (82009-84999) (2 of 2) Samples from different sources, reported separately e.g., blood, feces Samples taken at different times of day reported separately

  21. Molecular Pathology (81105-81408, 81479) • 81105-81383 are Tier 1 procedures that report molecular assay • More common gene specific procedures • Example, breast cancer gene–81162 (BRCA1 and BRCA2) • 81400-81408 are Tier 2 procedures to report less commonly performed analyses • 81479 reports unlisted molecular pathology procedures

  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 Figure 25.4 From Abbott: CELL-DYN Emerald 22 Hematology Analyzer (website): https://www.corelaboratory.abbott/us/en/offerings/brands/cell-dyn/cell-dyn-emerald22. Accessed August 8, 2018.

  23. Immunology (86000-86804) Identifying immune system conditions caused by antibodies and antigens Example: Hepatitis C antibody screening Tissue typing (86805-86849) Basic assay, screening, typing

  24. Tissue Typing (86805-86849) • Compatibility test on tissue • Match donor to recipient • Measure/monitor cytotoxic reactions

  25. Transfusion Medicine (86850-86999) Blood bank codes Tests performed on blood or blood products Do NOT identify supply of blood, but Collection Processing Typing Figure 25.5

  26. Microbiology (87003-87999) Study of microorganisms Identification of organism Sensitivities 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.

  27. Microbiology Caution Many code descriptions similar to those in Immunology (86000-86849) Difference is technique used Figure 25.6 Courtesy United States Environmental Protection Agency.

  28. Anatomic Pathology (88000-88099) Postmortem examinations Autopsies Reports only physician service Codes divided on extent of exam and type of exam (gross versus gross and microscope) Example: Gross exam without central nervous system (88000) Gross and microscopic without central nervous system (88020)

  29. Cytopathology (88104-88199) Identify cellular changes Common laboratory procedures e.g., Pap smear Codes divided on Type of procedure Technique used

  30. Cytogenetic Studies (88230-88299) Branch of genetics concerned with cellular abnormalities and pathologic conditions Example: Chromosomes

  31. Surgical Pathology (88300-88399) (1 of 3) Evaluation of specimens to determine disease pathology All tissue removed during procedures undergoes pathology evaluation

  32. Surgical Pathology (88300-88399) (2 of 3) Operative report usually coded after pathology report received Pathology reports usually coded with OR

  33. Surgical Pathology (88300-88399) (3 of 3) Unit of measure (88300-88309), specimen Two anus tags, each examined, 88304 x 2 One anus tag examined in two different areas of tag, 88304

  34. Types of Pathologic Examination Microscopic: With microscope Gross: Without microscope 88300, only gross exam code Others gross and microscopic Courtesy of Cynmar Corporation, Carlinville, IL

  35. Six Levels of Surgical Pathology (1 of 2) Based on specimen examined e.g., breast, prostate, lung And reason for evaluation e.g., radical procedure for suspected carcinoma

  36. Six Levels of Surgical Pathology (2 of 2) Levels divided on complexity of examination Examples: 88305: Colon, biopsy 88307: Colon, segmental resection, other than for tumor 88309: Colon, total resection

  37. 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 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.

  38. Not Included In Codes 88300-88309 Additional service codes 88311-88399 are not included in codes 88300-88309 Example: Special stains (88312) Additional services reported separately

  39. ConclusionCHAPTER 25 PATHOLOGY / LABORATORY

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