Pathology and laboratory

Pathology and laboratory-CPT GUIDELINES BY BHARATH KUMAR MEDESUN STUDENT

1. PATHOLOGY AND LABORATORY

2. INTRODUCTION What is pathology? Pathology   is a significant component of the causal study of disease and a major field in modern medicine and diagnosis . Range of code(80047-89398)

3. Organs or disease oriented panels These panels were developed for coding purpose only and should not be interpreted as clinical prameters . The tests listed with each panel identify the defined components of that panel. If one performs tests in addition to those specifically indicated for a particular panel,those tests should be reported separately in addition to the panel code.

4. Do not report 2 or more panel codes that include any of the same constituent tests performed from the same patient collection. If a group of tests overlaps 2 or more panels,report the panel that incorporates the greatest number of tests to fulfill the code and report the remaining tests using individual test codes.

5. DRUG ASSAY Drug procedures are divided into 3 subsections Therapeutic drug assay Drug assay Chemistry Two major categories for drug testing in the drug assay

6. PRESUMPTIVE DRUG CLASS Procedures are used to identify use or non-use of a drug or drug class. A presumptive test may be followed by a definitive test in order to specifically identify drugs or metabolites.

7. DEFINITIVE DRUG CLASS Procedures are qualitative or quantitative tests to identify possible use or non-use of a drug. These tests identify specific drugs and associated metabolites,if performed. A presumptive test is not required prior to a definitive drug test. TDA procedures are typically quantitative tests and the specimen type is blood,urine serum,CSF .

8. When the same procedure is performed on more than one specimen type, the appropriate code is reported separately for each specimen type using modifier-59

9. EVOCATIVE/SUPPRESSION TESTING These test panels involve the administration of evocative or suppressive agents and the baseline and subsequent measurements of their effects on chemical constituents. These codes are to be used for reporting of the laboratory component of the overall testing protocol. Ex:hydration,therapeutic injections, infusions etc…

10. CONSULTATIONS It is a service provided by a pathologist in response to a request form a physician or qualified health care professional in relation to a test results requiring additional medical interpretive judgement . Reporting of a test result without medical interpretive judgement is not considered a clinical pathology consultation. Code range(80500-80502)

11. URINALYSIS Examination of the urine for a required test is known as urinalysis. Generally which is carried out in laboratory section Code range(81000-81099)

12. MOLECULAR PATHOLOGY These procedures are medical laboratory procedures involving the analysis of nucleic acid to detect variants in genes that may be indicative of germline or somatic conditions Code section is typically based on the specific gene that is being analyzed.

13. For microbial identifiaction see87149-87153 and 87470-87801 and 87900-87904. For in situ hybridization analyses see88271-88275 and 88365-88368 Molecular pathology that are not specified in 81161,81200-81383 should be reported using either the appropriate tier 2 code(81400-81408) or the unlisted molecular pathology procedure code 81479.

14. TIER 1 MOLECULAR PATHOLOGY These codes represent gene-specific and genomic procedures Range of code(81161-81355) HLA(human leukocyte antigen) typing is performed to assess compatibility of recipients nd potential donors as a part of solid organ and hematopoietic stem cell pretransplant testing.

15. HLA testing is also performed to identify HLA alleles and allele groups associated with specific diseases and individualized response to drug therapy(eg;HLA-B27,HLA-B57.01) as well as other clinical uses. Range of code(81370-81383)

16. TIER 2 MOLECULAR PATHOLOGY The following molecular pathology procedures codes are used to report procedures not listed in the tier 1 molecular pathology codes(81161,81200-81383). If the analyte tested is not reported under tier2 codes or tier1 codes,use the unlisted molecular pathology procedure code81479. Range of code(81400-81479)

17. GENOMIC SEQUENCING PROCEDURES Genomic sequencing procedures and other molecular multianalyte assays GSPs are DNA or RNA sequence analysis methods that simultaneously assay multiple genes or genetic regions relevant to a clinical situation. This technology commonly reffered as next generation sequencing(NGS) Range of code(81410-81471)

18. MULTIANALYTE ASSAYS WITH ALGORITHMIC ANALYSES Used to report a numeric score or a probability based upon multiple results derived from panels of analyses of various types. Algorithmic analysis using these results as well as other patient information. Code range(81490-81599)

19. CHEMISTRY When an analyte is measured in multiple specimens that are obtained at different times,the analyte is reported separately for each source and for each specimen. When the requested analyte result is derived using a calculation that requires values from nonrequested laboratory analyses,only the requested analyte code should be reported. Range of code(82009-84999)

20. HEMATOLOGY AND COAGULATION Study of blood and its constituents is known called as hematology. Coagulation  (also known as  clotting ) is the process by which blood changes from a liquid to a gel, forming a blood clot. It potentially results in hemostasis, the cessation of blood loss from a damaged vessel, followed by repair. Range of code(85002-85999)

21. IMMUNOLOGY Immunology is a branch of biology that covers the study of immune systems in all  organisms. Range of code(86000-86804)

22. TISSUE TYPING Tissue typing  is a procedure in which the tissues of a prospective donor and recipient are tested for compatibility prior to transplantation.  Range of code(86805-86849)

23. TRANSFUSION MEDICINE Transfusion medicine  is the branch of medicine that is concerned with transfusion of blood and blood components. Range of code(86850-86999)

24. MICROBIOLOGY Microbiology  is the study of microscopic organisms.  Microbiology encompasses numerous sub-disciplines including virology, mycology, parasitology , and bacteriology . Presumptive identification of microorganisms is defined as identification by colony morphology,growth on selective media,gram stains or up to three tests.

25. Definitive identification of microorganisms is defined as an identification to the genus or species level that requires additional tests. If additional tests required use separate codes 87140-87158 in addition to definitive identification codes. Repeat laboratory tests performed on the same day use modifier 91. Range of code(87003-87999)

26. ANATOMIC PATHOLOGY Procedures 88000-88099 represent physician services only Use modifier 90 for outside laboratory services Coroner’s call:- response to a crime scene 88045.

27. CYTOPATHOLOGY Cytopathology is a branch of pathology that studies and diagnoses diseases on the cellular level . Codes 88141-88155,88164-88167,88174-88175 are used to report cervical or vaginal screening by various methods and to report physician interpretation services. Use codes 88150-88154 to report conventional pap smears that are examined using the bethesda system reporting.

28. Use codes 88142-88143 to report liquid based specimens processed as thin layer preparations that examined using any system of reporting. Use codes 88174-88175 to report automated screening of liquid based specimens that are examined using any system of reporting.

29. Codes 88141 and 88155 should be reported in addition to the screening code chosen when the additional services are provided. Range of code(88104-88199)

30. CYTOGENIC STUDIES Cytogenetics  is a branch of genetics that is concerned with how the chromosomes relate to cell behaviour , particularly to their behaviour during mitosis and meiosis . Range of code(88230-88299)

31. SURGICAL PATHOLOGY Services 88300-88309 includes accession,examination and reporting. They do not include the services designated in codes 88311-88365 and 88399,which are coded in addition when provided The unit of service for codes 88300-88309 is the specimen.

32. Do not report 88302-88309 on the same specimen as part of mohrs surgery. Range of code(88300-88399)

33. IN VIVO LABORATORY PROCEDURES Studies that are  in vivo   are those in which the effects of various biological entities are tested on whole, living organisms or cells, usually animals, including humans, and plants as opposed to a tissue extract or dead organism . Range of code(88720-88749)

34. REPRODUCTIVE MEDICINE PROCEDURES It includes invitro fertilzation studies Range of code(89250-89398)

35. EXAMPLES OF PATHOLOGY Ex:Dr.john performed lipid panel and blood quantitative glucose Ans:80061 lipid panel,82947 blood glucose quantitative Ex: Dr.john performed metabolic panel on automated equipment in his office. Ans:80053

36. Ex:A basal cell carcinoma is removed from patients shoulder and submitted for frozen section to pathologist providing consultation.specimen is evaluated surgeon submitted another frozen section for examination Ans:88331 and +88332

37. Ex:The physician performed core biopsy of a mass from the hand diagnosed as sarcoma Ans;88307 RATIONALE: a soft tissue mass other than lipoma subjected to biopsy or simple excision should be reported using 88307. https://www.medesunglobal.com

38. THANK YOU