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
1. Therapeutic drug assay
2. Drug assay
3. 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.
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38. THANK YOU