Organ or Disease-oriented panels

 

• The codes in the Organ or Disease-Oriented Panels subsection (80047- 80081) are grouped according to the usual laboratory work ordered by a physician for the diagnosis of or screening for various diseases or conditions.

 

• Groups of tests may be performed together using automated equipment, depending on the situation or disease.

 

• For example, during the first obstetric visit, a mother is commonly asked to have baseline laboratory tests performed to ensure that appropriate antepartum care is provided.

 

• To assign a panel code, each test listed in the panel description must be performed. Additional tests are reported separately. The development of panels saves the facility from having to report each test separately, and it is often more economical for the patient.

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• You cannot assign modifier -52 (reduced service) with a panel.

 

• For example, if all of the tests in the obstetric panel were done except the syphilis test, you could not report 80055 (Obstetrical Panel) with modifier -52. You would instead list each of the tests separately.

 

NOTE: Be careful when coding multiple panels on the same day for the same patient. Sometimes several panels include some of the same tests. For example, a hepatitis B surface antigen test is included in both the obstetric panel and the acute hepatitis panel. It would be inappropriate to report the same test twice.

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• The laboratory and pathology reports in the patient medical record will describe the method by which the test was performed. There are many different methods of performing the same test. For example, a urinalysis can be automated or nonautomated and can include or exclude microscopy. It is necessary to know these details if you are to assign the correct urinalysis code. If the details you need are not in the medical record, ask the laboratory staff or physician for further clarification. Drug Assay

 

• Laboratory Presumptive Drug Class Screening (80305-80307) is performed to identify the presence or absence of a drug. Testing that determines the presence or absence of a drug is qualitative (the drug is either present or not present in the specimen)

 

• The screening of drug classes is divided by method, including visual, instrument, and chemical. Codes 80305- 80307 report drug screening of any number of drug classes.

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Therapeutic Drug Assays

• Therapeutic drug assays (80150-80299) test for a specific drug and for the amount of that drug. Many types of drugs are listed in this subsection. If the drug is not listed, it is possible that quantitative analysis may be listed under the methodology (e.g., immunoassay, radioassay).

 

• Therapeutic drug assays are performed to help the physician monitor the level of medication in the patient’s system or to monitor the patient’s compliance. • The drugs are listed by their generic names, not their brand names. A Physician’s Desk Reference that lists pharmaceuticals by the generic and brand name will be helpful as you code drug testing and assays. • One location of Drug Testing codes in the index of the CPT manual is under the main term “Drug,” subtermed by the reason for the tests —analysis or confirmation. Therapeutic Drug Assay subsection codes can be found under the main term “Drug Assay” and subterms of the material examined, for example, amikacin, digoxin.

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Evocation/Suppression testing

 

• Evocative/Suppression (80400-80439) testing is performed to measure the effect of evocative or suppressive agents on chemical constituents. For example, 80400 is reported when a patient undergoes testing to determine whether adrenocorticotropic hormone (ACTH) is being produced in the body. The patient may have adrenal gland insufficiency.

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• To code the components of Evocative/Suppression Testing consider the following:

 

• If the physician supplied the agent, report the supply using 99070 from the Medicine section or a HCPCS code.

 

• If the physician administered the agent, report the infusion or injection with codes 96365-96379 from the Medicine section.

 

• If the test involved prolonged attendance by the physician, report the service with the appropriate E/M code. NOTE: Remember that the codes from the Pathology and Laboratory section are only for the tests performed and do not reflect the complete service provided to the patient.

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• A clinical pathologist, upon request from a primary care physician, will perform a consultation to render additional medical interpretation of test results.

 

• There are two codes under the subsection Consultations (80500, 80502). These consultations are based on whether the consultation was limited or comprehensive. A limited consultation is one that was done without the pathologist’s review of the medical record of the patient, and a comprehensive consultation is one in which the medical record was reviewed as a part of the consultative services. When either of these consultation codes is submitted to a third-party payer, the submission is accompanied by a written report.

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Consultation (Clinical Pathology)

 

• These are not the only consultation codes in the Pathology and Laboratory section of the CPT manual. There are also consultation codes toward the end of the section in the Surgical Pathology subsection (88321-88334) that report the services of a pathologist who reviews and gives an opinion or advice concerning pathology slides, specimens, material, or records that were prepared elsewhere or for pathology consultation during surgery.

 

• Pathology consultations during surgery are provided to examine tissue removed from a patient during a surgical procedure. If the pathologist did not use a microscope to examine the tissue, report 88329. If a microscope was used to examine the tissue, report 88331 or 88332, depending on the number of specimens that were examined.

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 • A specimen is a sample of tissue from a suspect area; a block is a frozen piece of a specimen; and a section is a slice of a frozen block. A pathologist prepares a specimen by cutting it into blocks and taking sections from the blocks.

 

• The number of sections taken depends on the judgment of the pathologist as to the number of areas of the specimen that need to be examined. The frozen section is placed (mounted) on a slide or held by other means that allow the pathologist to view the tissue under a microscope. • When one block is sectioned and examined, the service of examining that first section is reported using 88331. The second and subsequent sections of the same block are included in the reporting of 88331. If another block from another area (a second block) was sectioned, the first section would be reported using 88331, and subsequent sections from the second block using 88332. You cannot use 88332 without first reporting 88331. Code 88332 is marked as an add-on code (one that is used only with another code), its function is to report subsequent sections that were examined.

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Urinalysis, Molecular Pathology, and Chemistry

 

• Many types of tests are located under the Urinalysis, Molecular Pathology, and Chemistry subsections (81000- 84999).

 

• Urinalysis codes are for nonspecific tests performed on urine. Chemistry codes are for specific tests performed on material from any source (e.g., urine, blood, breath, feces, sputum)

 

• For example, a urinalysis using a dipstick (81000-81003) would report the presence and quantity of the following constituents: bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and urobilinogen. Any number of these constituents may be analyzed and reported using a code from the Urinalysis subsection (81000-81099)

 

• However, if the physician ordered an analysis of the urine specifically to determine the presence of urobilinogen (reduced bilirubin) and the exact amount of urobilinogen present (quantitative analysis), you would choose a code (84580) from the Chemistry subsection.

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• The main things to remember when coding from these two subsections are:

 

• Identify specific tests

• Determine if the test was automated (by machine) or nonautomated (manual)

• Number of tests performed

• Identify combination codes for similar types of tests

• Whether the results are qualitative or quantitative

• Method of testing

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• The Molecular Pathology codes are divided into Tier 1 and Tier 2 codes.

 

• Tier 1 codes (81161, 81200-81383) report services for molecular assays that are more commonly performed.

 

• For example, 81211 is an essay to determine the presence of a breast cancer gene—BRCA1 (breast cancer 1) and BRCA2 (breast cancer 2).

 

• There are many conditions in which a genetic predisposition can be predicted, such as cystic fibrosis and colon cancer.

 

• Tier 2 codes 81400-81479 involve less commonly performed analyses and are arranged by the required level of technical resources and the level of physician interpretation or other qualified health professional.