Chapter 6 Pathology and Laboratory Principles of CPT

Chapter 6: Pathology and Laboratory Principles of CPT® Coding, Ninth Edition The AMA assumes no responsibility for use of the information contained in this publication. The AMA shall not be responsible for, and expressly disclaims liability for, damages of any kind arising out of the use of, reference to, or reliance on, the content of this publication. This publication is for informational purposes only. © 2017 American Medical Association. All rights reserved. 1

Pathology and Laboratory Learning Objectives After completion of this chapter, students should be able to: § Explain the format of the Pathology and Laboratory section § Demonstrate an understanding of Pathology and Laboratory terminology § Understand how Organ or Disease Oriented Panels are reported § Understand how specimens are collected for Pathology and Laboratory services § Understand how laboratory specific modifiers are used © 2017 American Medical Association. All rights reserved. 2

Pathology and Laboratory Subsections § Organ or Disease-Oriented Panels (80047 -80081) § Drug Assay - Presumptive Drug Class Screening (80305 -80307) - Definitive Drug Testing (80320 -80377) § Therapeutic Drug Assays (80150 -80299) § Evocative/Suppression Testing (80400 -80439) § Consultations (Clinical Pathology) (80500 -80502) § Urinalysis (81000 -81099) © 2017 American Medical Association. All rights reserved. 3

Pathology and Laboratory Subsections (continued) § Molecular Pathology (gene-specific and genomic procedures) - Tier 1 procedures (81161 -81383) - Tier 2 procedures (81400 -81479) § Genomic Sequencing Procedures and Other Molecular Multianalyte Assays (81410 -81479) § Multianalyte Assays with Algorithmic Analyses (81490 -81599) § Chemistry (82009 -84999) § Hematology and Coagulation (85002 -85999) § Immunology (86000 -86849) © 2017 American Medical Association. All rights reserved. 4

Pathology and Laboratory Subsections (continued) § Transfusion Medicine (86850 -86999) § Microbiology (87003 -87999) § Cytopathology (88104 -88199) § Cytogenetic Studies (88230 -88299) § Surgical Pathology (88300 -88399) § In Vivo (eg, Transcutaneous) Laboratory Procedures (88720 -88749) § Other Procedures (89049 -89240) § Reproductive Medicine Procedures (89250 -89398) © 2017 American Medical Association. All rights reserved. 5

Pathology and Laboratory Terms Collection of Specimen: § Via venipuncture, arterial puncture, or other collection methodology, (eg, lumbar puncture) not included in lab tests § 80000 code series report only performance of specific lab test Organ or Disease-Oriented Panels: § § Developed for coding purposes; not to be interpreted as clinical standards for testing To report a panel, all tests in definition must be performed, no substitutions Tests performed in addition to panel are separately reported Panel components do not limit performance of other tests © 2017 American Medical Association. All rights reserved. 6

Pathology and Laboratory Terms (continued) Drug Assay § Quantitative or qualitative evaluation to identify impurities, toxicity, or other characteristics § 2 categories in Drug Assay subsection: Presumptive drug class screening procedures and definitive drug testing procedures Therapeutic Drug Assays § Quantitative measurement of drugs in blood or cerebrospinal fluids § Specimen is whole blood, serum, plasma, or cerebrospinal fluid § Coding based on parent drug © 2017 American Medical Association. All rights reserved. 7

Pathology and Laboratory Terms (continued) Evocative or Suppression Testing § Test panels for the laboratory component of overall testing of evocative or suppressive agents § Report separately the administration of evocative or suppressive agents, (eg, 96365 -96368, 96372, 96374 -96376) Consultations (Clinical Pathology) § Clinical pathology consultations (80500 -80502) § Consultation on referred material (88321 -88325) § Pathology consultation during surgery (88329 -88334) © 2017 American Medical Association. All rights reserved. 8

Pathology and Laboratory Terms (continued) Molecular Pathology § Procedures involving analyses of nucleic acid (ie, DNA, RNA) to detect gene variants § Code selection based on specific gene(s) being analyzed Multianalyte Assays with Algorithmic Analyses (MAAAs) § Use results from panels of analyses including molecular pathology assays or fluorescent in situ hybridization assays § Algorithmic analysis is performed; reported as a numeric score or probability © 2017 American Medical Association. All rights reserved. 9

Pathology and Laboratory Terms (continued) Chemistry § Material for exam from any source unless indicated in code descriptor § Exam is quantitative unless otherwise specified in code descriptor § Analyte reported separately when measured in multiple specimens from different sources © 2017 American Medical Association. All rights reserved. 10

Modifier Usage § Modifier 26 - Professional Component § Modifier 59 - Distinct Procedural Service § Modifier 91 - Repeat Clinical Diagnostic Laboratory Test § Modifier 92 - Alternative Laboratory Platform Testing © 2017 American Medical Association. All rights reserved. 11