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Pathology and Lab Section – Index located on Page 385 – 387 in CPT Book
 Formatted according to the type of tests performed. Pg 690 SBS TB
 Modifier -51 is not used on lab and path
 Modifier -76 is used if the test is repeated by the same physician
 Modifier -77 is used if the test is repeated by a different physician
 Modifier -90 is used if the test is sent to an outside lab
 Modifier -91 is used for a repeat clinical diagnostic lab test
 CPT Index Look-up terms: you may have to look elsewhere
o Therapeutic
o Test
o Individual
o Blood Tests and then panels
o Immunoassay
o Drug Assay
o Drug
Labs have built-in indicators that allow additional tests to be performed without a written order from
the physician. (pg 690 SBS TB)
 Standards set by the medical facility
 Imply that when a certain test is positive, it is assumed that the physician would want further
information on the condition and specific additional tests are to be performed.
 Only bill when the lab has actually been done, not when it’s been ordered
 The services in this section only include the lab tests
 The collection of the specimen is reported separately
Billing in the clinic:
 The clinic bills for the venipuncture (nurse draws your blood while you wait for the doctor) –
CPT 36415
 Lab bills the 80,000 code for the actual testing of the blood
Linking Diagnosis:
http://www.cms.gov/mcd/index_section.asp?ncd_sections=40
As you click deeper into the National Coverage Guidelines, you will find 23 different types of
lab tests and their linking diagnosis. Below is an example from the above listed website:
Code: Descriptor:
87086 Culture, bacterial; quantitative, colony count, urine.
87088 Culture, bacterial; with isolation and presumptive identification of isolates, urine
87184 Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents).
ICD-9-CM Codes Covered by Medicare Program
Code: Descriptor:
003.1 Salmonella septicemia
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038.0-038.9 Septicemia
276.2 Acidosis
276.4 Metabolic acidosis/alkalosis
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MEDICAL BILLING AND CODING
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Blood Panels:
Organ or Disease Oriented Panels – pg 690-691 SBS TB
 CPT Code Range - 80047-80076, pg 389-390 CPT
 Performed for the diagnosis of or screening for various disease or conditions
http://rarediseases.about.com/od/medicalterms/g/cbc.htm
http://www.maexamhelp.com/blood_panel.htm
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Pg 691 Coding Shot
 If a panel is ordered, and one of the tests are not performed, each test must be coded
separately.
Drug Testing: pg 691-692 SBS TB
 CPT Code Range (80100-80103), pg 390-391 CPT
 Performed to identify the presence or absence of a drug
o Qualitative – drug is either present or not present in the specimen (yes or no question)
o Quantitative – another test performed to identify the exact amount of the drug that is
present (how much question)
Therapeutic Drug Assays - pg 692-693 SBS TB
 CPT Section (80150-80299) – CPT - pg 391
 Performed to monitor the level of medication in the patient’s system
 Make sure the patient is getting the correct level of medication
 Performed to monitor the patient’s compliance
 If you can’t find the test, try looking under immunoassay, radioassay
 The drugs are listed under their generic name, not the brand name
 Look under “Drug” or “Drug Assay” in the CPT Book index – pg 636
 Look under “Therapeutic” – tells you to look elsewhere
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Evocative / Suppression Testing – pg 693-694 SBS, pg 391-393 SPT
Determine baseline level of chemicals after taking prescribed substance
Ex. Patient takes thyroid medicine after a thyroidectomy
Consultations (Clinical Pathology) – One who will prepare additional information about a patient’s
pathology to the physician who requests this information. Pg 694 SBS TB, Pg 393 CPT
Code Range (80500, 80502)
A written report needs to be done.
In CPT, look under Pathology on page 708 CPT.
2 sections
1. Clinical Consults
2. Surgical Consults
For the reports in your workbooks – go to page 422-424
Other consult codes for the Surgical Path subsection (88321-88334), pg 694 SBS TB
CPT pg 425
 Pathologist reviews specimens while the patient is having surgery
o Specimen – sample of tissue from a suspect area
o Block – a frozen piece of a specimen
o Section – slice of a frozen block
 Read coding shot on page 694 and add to CPT if necessary
Urinalysis and Chemistry (81000-84999) – pg 695-696 SBS TB
Urinalysis codes are for nonspecific tests – pg 393-394 CPT
Chemistry codes are for specific tests performed on the material from any source
Pg394-405 CPT
Ex. 82272 vs 82274 – Ingenix Encoder Pro
82272 – The test may be requested as a screening guaiac or screening stool guaiac. This test
is a screening test to detect blood in the digestive tract. The patient is instructed to obtain three
consecutive stool specimens and send the kit to a lab or physician office for performance of the test.
Looking for hidden blood in the stool sample. Also used if the doctor takes a single specimen from
the patient during a digital rectal exam. Not to be used for patients who are being screened for
colorectal neoplasm screening.
82274 – Requires 3 separate bowel movements, and each sample must be placed in a sterile
leakproof container with a screw-cap lid for transport to the lab
Hematology and Coagulation (85002-85999) – pg 696-697 SBS TB, pg 405-408 CPT
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o Blood count – checks for how many red and white blood cells you may or may not have
o To clot or not to clot, that is the question
 The codes are divided based on the particular factor being tested
o Most of the tests are located in the CPT test under the name of the test, ex.
Prothrombin time, coagulation time, or hemogram.
Immunology (86000-86804) – pg 698 SBS TB, pg 408-412 CPT
 Has to do with your immune system: Allergies, hypersensitivity, allergy testing
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Transfusion Medicine (86850-86999), pg 698-699 SBS TB, 413-414 CPT
http://en.wikipedia.org/wiki/Transfusion_medicine
Transfusion medicine (or transfusiology) is the branch of medicine that is concerned with the
transfusion of blood and blood components. The blood bank is the section of the clinical laboratory
where medical technologists process and distribute blood products under the supervision of a
medical director, often certified in Pathology or Transfusion Medicine. The blood donor center,
also under the supervision of a physician who may be a Transfusion Medicine specialist, is the
facility that collects and processes blood products.
Microbiology (87001-87999) – study of microorganisms and includes the study of bacteria, fungi,
parasites, and viruses. Pg 699-670 SBS TB, 414-419 CPT
Ex. Remember growing mold in a petri dish?
Anatomic Pathology (88000-88099) - pg 700-701 SBS TB, pg 419 CPT
 Used to report examination of body fluids or tissues after death
 Divided according to the extent of the exam
 Also contains codes for forensic examination and coroner’s calls
Cytopathology and Cytogenic Studies (88104-88199) – pg 701 SBS TB, 419-422 CPT
 Used to determine cellular changes (Ex. Pap Smear)
Surgical Pathology (88300-88399) – evaluation of specimens to determine the pathology of diseases
processes. Pg 701-702 SBS TB, 422-426 CPT
 Based on levels, range is Level 1 through Level 6
 See coding shot on page 702
Staining
Note: Each insurance has different guidelines for modifier usage
 Immunocytochemistry - 88342
 Special Stain – 88312-88314
 Staining – 88312-88314
 Staining pieces of the tumor (e.g. breast cancer)
o They may stain the pieces of the tumor several times- 88360
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