CHAPTER 29 PATHOLOGY LABORATORY Copyright 2014 by Saunders

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

Pathology and Laboratory Figure: 29. 1 laboratory • Codes for _____ test only collection • Specimen ________ coded separately – Example: Venous blood draw reported _____ 36415 (Surgery section) From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders. • Medicare fee schedule each year identifies those lab tests associated with a physician component (-26) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 3

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

Pathology/Laboratory Caution • Usually report second or subsequent tests without -51, multiple procedures •

Organ or Disease-Oriented Panels (80047 -80076) • Groups of tests often ordered together – Example: • Basic Metabolic Panel • General Health Panel • Electrolyte Panel Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 6

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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 7

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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 8

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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 9

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…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 10

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

Therapeutic Drug Assays (80150 -80299) amount (quantitative) or • Reports presence and ______ absence of a substance • Material examined can be from any source _____ generic names • Drugs listed by ______ – 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 12

Evocation/Suppression Testing (80400 -80440) • Measures stimulating (evocative—calling forth a response) or suppressing agents • Codes report only TC of service Technical Component – TC = __________ (Cont’d…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 13

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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 16

Pathology Terminology • Specimen ____: Sample of tissue of suspect area Figure: 29. 2 Block : Frozen piece of • _____ specimen • Section ______: Slice of frozen block – Example: Pathologist consults during surgical procedure • Examines one ___ block = 88331 Courtesy National Institute of Environmental Health Sciences— National Institutes of Health. each additional • Examines _______ section of same block = 88332 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 17

Urinalysis (81000 -81099) • Tests on urine Figure: 29. 3 – Method of test • e. g. , tablet, reagent, or dipstick – Reason for test • e. g. , pregnancy – Constituents being tested for • e. g. , bilirubin, glucose From Proctor DB, Adams AP: Kinn's The Medical Assistant: An Applied Learning Approach, ed 12, St. Louis, 2014, Saunders. (Cont’d…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 18

Urinalysis (…Cont’d) • Equipment used nonautomated – Automated or ______ – With or without

Chemistry 82000 -84999 • Specific tests on any bodily substances – Urine – Breath – Blood – Feces quantitative (specific • Most chemistry tests are _____ amount) unless specified qualitative (Cont’d…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 20

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

Molecular Pathology (81161, 81200 -81479) • 81161, 81200 -81383 are Tier 1 procedures that report molecular assay – More common gene specific procedures – Example, breast cancer gene– 81211 (BRCA 1 or BRCA 2) • 81400 -81479 are Tier 2 procedures to report less commonly performed analyses • 81479 reports unlisted molecular pathology procedures Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 22

Hematology and Coagulation (85002 -85999) Figure: 29. 4 • Laboratory procedures on blood – Example blood count (CBC) • Complete _________ White blood cell count (WBC) • _________ • Codes divided based on method of – Blood draw – Test being conducted Copyright © 2014 by Saunders, an imprint of Elsevier Inc. From Clinical Diagnostic Solutions, Inc. : M-Series Hematology Analyzer CAP. (website): http: //cdsolinc. com/index. php? main_ page=product_info&c. Path=7_44&products_id=97. Accessed February 9, 2013. Slide 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 24

Tissue Typing (86805 -86849) • Compatibility test on tissue • Match donor to recipient

Transfusion Medicine (86850 -86999) • Blood bank codes • Tests performed on blood or blood products • Do NOT identify supply of blood, but – Collection – Processing Figure: 29. 5 – Typing _____ Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 26

Microbiology (87001 -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. Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 27

Microbiology Caution Figure: 29. 6 • Many code descriptions similar to those in Immunology (86000 -86849) • Difference is technique ____ used Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Courtesy United States Environmental Protection Agency. Slide 28

Anatomic Pathology (88000 -88099) • Postmortem examinations – Autopsies • Reports only ____ physician service extent of exam and ____ • Codes divided on _____ type of exam (gross versus gross and microscope) – Example: • Gross exam without central nervous system (88000) • Gross and microscopic without central nervous system (88020) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 29

Cytopathology (88104 -88199) • Identify cellular changes • Common laboratory procedures – e. g. , Pap smear • Codes divided on – Type ____ of procedure – Technique ____ used Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 30

Cytogenetic Studies (88230 -88299) • Branch of genetics concerned with cellular ______ abnormalities and pathologic conditions – Example: Chromosomes From Goldman L, Schafer AI, editors: Goldman's Cecil Medicine, ed 24, Philadelphia, 2012, Saunders. Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 31

Surgical Pathology (88300 -88399) • Evaluation of specimens to determine disease pathology • All tissue removed during procedures undergoes pathology evaluation (Cont’d…) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 32

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

Surgical Pathology (…Cont’d) • Unit of measure (88300 -88309), specimen • Two anus tags, each examined, 2 88304 x _ • One anus tag examined in two different areas of tag, 88304 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 35

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

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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 37

Levels • Level I The Gram’s stain. Red blood cells (RBC) and gram-positive cocci. – 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 From Mc. Pherson RA, Pincus MR: Henry’s Clinical Diagnosis and Management by Laboratory Methods, ed 22, St. Louis, 2011, Saunders. • Same anatomical site can be listed in each level Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 39