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CHAPTER 29

CHAPTER 29. PATHOLOGY / LABORATORY. 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

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CHAPTER 29

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  1. CHAPTER 29 PATHOLOGY / LABORATORY

  2. 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

  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 (-26) Figure: 29.1 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 -51, multiple procedures Rather report times (x)

  6. Organ or Disease-Oriented Panels (80047-80076) 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 & be medically necessary Do not use -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. 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) (Cont’d…)

  9. Drug Testing (…Cont’d) 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 (Cont’d…)

  10. Drug Testing (…Cont’d) Code the number of procedures, not the number of drugs tested for Example: Two procedures to identify three drugs = 80100 × 2 One procedure to identify three drugs = 80100 (Cont’d…)

  11. Drug Testing (…Cont’d) Does not identify amount of drug present Only presence or absence Quantitative analysis tests for specific amount of analyte present

  12. 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 testing Measures peaks (after drug given at intervals) and troughs (before drug given next dose)—used to monitor therapeutic drug for medication adjustment

  13. Evocation/Suppression Testing (80400-80440) Measures stimulating (evocative—calling forth a response) or suppressing agents Codes report only TC of service TC = Technical Component (Cont’d…)

  14. 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

  15. 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

  16. 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

  17. 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: 29.2 Courtesy National Institute of Environmental Health Sciences—National Institutes of Health.

  18. Urinalysis (81000-81099) 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…) Figure: 29.3 From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders.

  19. Urinalysis (…Cont’d) Equipment used Automated or nonautomated With or without microscope Number of tests performed

  20. Chemistry 82000-84999 Specific tests on any bodily substances Urine Blood Most chemistry tests are quantitative (specific amount) unless specified qualitative (Cont’d…) • Breath • Feces

  21. Chemistry (…Cont’d) Samples from different sources, reported separately e.g., blood, feces Samples taken at different times of day reported separately

  22. 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 (BRCA1 or BRCA2) • 81400-81406 are Tier 2 procedures to report less commonly performed analyses

  23. 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: 29.4 From Clinical Diagnostic Solutions, Inc.: M-Series Hematology Analyzer CAP. (website): http://cdsolinc.com/index.php?main_ page=product_info&cPath=7_44&products_id=97. Accessed January 20, 2011.

  24. 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

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

  26. 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: 29.5

  27. Microbiology (87001-87999) Study of microorganisms Identification of organism Sensitivities of organism to antibiotics From Mandell GL, Bennett JE, Dolin R, editors: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, ed 6, Philadelphia, 2005, Churchill Livingstone.

  28. Microbiology Caution Many code descriptions similar to those in Immunology (86000-86849) Difference is technique used Figure: 29.6 Courtesy United States Environmental Protection Agency.

  29. 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)

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

  31. Cytogenetic Studies (88230-88299) Branch of genetics concerned with cellular abnormalities and pathologic conditions Example: Chromosomes From Goldman L, Ausiello D, editors: Cecil Textbook of Medicine, ed 22, Philadelphia, 2004, Saunders.

  32. Surgical Pathology (88300-88399) Evaluation of specimens to determine disease pathology All tissue removed during procedures undergoes pathology evaluation (Cont’d…)

  33. Surgical Pathology (…Cont’d) Operative report usually coded after pathology report received Pathology reports usually coded with OR (Cont’d…)

  34. Surgical Pathology (…Cont’d) 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

  35. 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

  36. Six Levels of Surgical Pathology Based on specimen examined e.g., Breast, prostate, lung And reason for evaluation e.g., Radical procedure for suspected carcinoma (Cont’d…)

  37. Six Levels of Surgical Pathology (…Cont’d) Levels divided on complexity of examination Example: 88305: Colon, biopsy 88307: Colon, segmental resection, other than for tumor 88309: Colon, total resection

  38. 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 21, St. Louis, 2007, Saunders.

  39. 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

  40. ConclusionCHAPTER 29 PATHOLOGY / LABORATORY

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