Chapter 17
CPT Pathology and
Laboratory
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Subsections
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Organ or disease-oriented panels
Drug testing
Therapeutic drug assays
Evocative/Suppression testing
Consultations (clinical pathology)
Urinalysis
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(continued)
Subsections
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Chemistry
Hematology and coagulation
Molecular diagnostics
Transfusion medicine
Microbiology
Anatomic pathology
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Subsections
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Cytopathology
Cytogenetic studies
Surgical pathology
Transcutaneous procedures
Other procedures
Reproductive medicine procedures
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Overview of Pathology and
Laboratory Section
• Describes services performed on specimens
(e.g., body fluids, tissue, cytological
specimens) to evaluate, prevent, diagnose,
or treat disease
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Laboratory Examinations
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Biophysical
Chemical
Cytological
Hematological
Immunohematological
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(continued)
Laboratory Examinations
• Microbiological
• Pathological
• Serological
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Laboratory Service Codes
• Most clinical laboratory service codes
include a technical component.
• Some services include both a technical and
professional component.
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Exercise 17.1
1. Although most clinical laboratory service
codes include a technical component, some
include both a technical and a __________
component.
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Pathology and Laboratory Sections
• Organization
– According to procedure performed
– Procedures listed alphabetically within each subsection
• Review patient record documentation, code
descriptions, and instructional notes
• Hospitals include pathology and laboratory
codes on a chargemaster, which is used to report
services and supplies for inpatient, outpatients and
emergency department patients.
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Exercise 17.1
2. Review of patient record documentation is
necessary before assigning pathology and
laboratory codes because many procedures
can be performed using different ________.
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Exercise 17.1
3. Hospital codes usually do not assign
pathology and laboratory codes because they
are included on a __________________,
which is used by providers to select services
provided to patients.
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Specimen Collection
• Laboratory codes describe performance of
lab tests
• Codes do not include collection of specimen
(reported separately)
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Exercise 17.1
4. CPT laboratory codes describe the
performance of lab tests, and they do not include
collection of the _________, which is performed
using different methods (e.g., venipuncture,
fingerstick, or lumbar puncture ) and is reported
separately.
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Exercise 17.1
5. The puncture of a vein using a needle for the
purpose of drawing blood as a common
method of collecting blood specimens is called
venipuncture, or ___________________.
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Professional and Technical
Components
• Certain laboratory procedures contain both
a professional (e.g., physician) and
technical component
– Technical component includes cost of equipment,
supplies, and technician salaries
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Exercise 17.1
6. A routine venipuncture (usually performed
by a nurse) is assigned code __________,
and it is reported in addition to the laboratory
procedure code.
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Exercise 17.1
7. When a physician’s sill is required to perform
the procedure, a code from range __________
is assigned.
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Coding Tip
• When pathology/laboratory service code
description includes both the technical and
professional component, and both
components were not performed, report the
appropriate code with its modifier:
– -26 (professional component only provided)
– -TC (technical component only provided)
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Exercise 17.1
8. When a pathology and laboratory procedure
code description includes technical and
professional components, and both components
were not performed, modifier _________ is
added to the code to indicate that only the
professional component was performed.
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Clinical Pathology
• Professional services include:
– Directing and evaluating quality assurance and control
procedures
– Supervising laboratory technicians
– Recommending follow-up diagnostic tests
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Coding Tip
• Modifier -90 [reference (outside)
laboratory] is reported to indicate that an
outside laboratory performed the service.
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Exercise 17.1
9. When an outside laboratory performs
pathology and laboratory services, add modifier
________ to a reported code.
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Clinical Laboratory Improvement Act
(CLIA)
• Physician office labs must obtain
certification to:
– Perform certain pathology and laboratory tests
– Submit claims to Medicare and Medicaid
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Exercise 17.1
10.To perform certain pathology and laboratory
tests (and to submit claims to Medicare and
Medicaid), physician office labs must obtain
certification under the _____________.
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Coding Tip
• When reporting CLIA-waived services to
Medicare or Medicaid, add HCPCS level II
modifier -QW to pathology and laboratory
codes.
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National Coverage Determinations
(NCD)
• Define coverage for services and procedures
• Developed by CMS to:
– Simplify administrative requirements for clinical
diagnostic services
– Promote national uniformity in processing Medicare
claims
• Medicare administrative contractors apply
NCDs nationwide
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Pathology and Laboratory Section
Guidelines
• Located at beginning of Pathology and
Laboratory section
• Provide instruction about:
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Services for pathology and laboratory
Separate or multiple procedures
Subsection information
Unlisted services or procedures
Special reports
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Exercise 17.2
1. The unit of pathology service is a _______,
which is tissue submitted for individual and
separate examination and pathological diagnosis.
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Exercise 17.2
2. During the same operative session, the surgeon
Submitted “incidental appendix” tissue and a
Section of fallopian tube (as a result of a
sterilization procedure) for pathological
evaluation. Refer to the notes located below the
Surgical Pathology subsection (codes 88300-88399)
To determine whether one or two codes are reported.
Code 88302 is reported _________ (once/twice).
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Exercise 17.2
3. It is appropriated to separately code and
report multiple pathology and laboratory
procedures that are provided on the same
_____________.
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Special Report
• Submitted when unlisted procedure or
service code is reported on claim
• Attached to submitted claim to clarify
service or procedure performed
• Should include description of nature, extent,
and need for procedure
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(continued)
Exercise 17.2
4. A service or procedure that is provided for
which there is no CPT code is reported with an
______________ code , and a __________
is attached to the submitted claim.
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Special Report
• May include:
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Complexity of symptoms
Final diagnosis
Pertinent physical findings
Diagnostic and therapeutic procedures
Concurrent problems
Follow-up care
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Modifiers
• -51 (multiple procedures)
– Not added to pathology and laboratory codes
• -91 (repeat clinical diagnostic laboratory
test)
– Added when procedures or services are repeated on
same date of service in order to obtain multiple results
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Exercise 17.2
5. When procedures or services are repeated on
the same date of service to obtain multiple
results, add modifier _________ to the
reported pathology and laboratory codes.
it is not appropriated to add modifier ______
to pathology and laboratory codes.
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