Labs and Path CPT Guidelines

Labs & Path CPT-

Hello Reader , In this Article we explain all about Labs and Path CPT Guidelines 2024 updates in an easy way you can find codes and any updates related to Labs and Path CPT Guidelines  and the code range of Labs and Path CPT Guidelines , and also you get modifier details that are used during the coding of Laboratory and Pathology CPT Guidelines . Lab and Path cpt code range start from 80047–89398. There are many modifiers used in Lab and Path  CPT guidelines, which are explained in this article in a very easy way with appropriate examples.

 

What is Pathology Test ? 

Pathology means the study of disease and its causes and progression. Pathology tests cover blood tests, and tests on urine, stools (faeces) and bodily tissues. If you’re sick, many of the decisions about your care will be based on the results of your blood and pathology tests.

 

What is laboratory test? 

A laboratory (lab) test is a procedure in which a health care provider takes a sample of your blood, urine, other body fluid, or body tissue to get information about your health. Lab tests may be used to: Help diagnose or screen for a specific disease or condition.

 

Difference between Laboratory and Pathology 

 

Laboratory : Laboratories perform a variety of tests and services, including biochemical, pathological, microbiological, hematological, and blood bank investigations. They can analyze blood and other body fluids for evidence of disease. 

Pathology: Pathologists diagnose diseases by examining cells and tissues, and they can perform autopsies to determine the cause of death. Pathology covers a range of topics, including cell injury, inflammation, and genetic diseases.

 

Abbreviations and Acronyms 

 

BAC : Blood alcohol content (or concentration)

CR : creatinine 

CSF : cerebrospinal fluid 

Hgb : hemoglobin 

MRSA : methicillin resistant staphylococcus aureus 

PSA : prostate specific antigen 

UA : urine analysis 

CBC : complete blood count 

 

Laboratory and Pathology Guidelines 

 

1. Don’t code E&M code with pathology chapter codes.

 

1. Don’t code surgery chapter codes with lab and pathology codes. 

 

1. Don’t use modifier 51 in this Chapter, So that directly eliminate if it is having 51 modifier with CPT code.

 

Modifier used in laboratory and Pathology

Modifier 90 :

Reference lab, assigned when the lab however the billing agreement is that the provider office will bill for the service.

Modifier 91 :

Repeat procedure; assigned when as identical pathology service is repeated (this must be the same CPT code).

Modifier 92 :

Alternative lab plateform testing assigned when the testing is performed utilzing or alternative lab plateform.

CLIA – waved test (QW modifier) :  

CLIA stands for clinical laboratory improvement amendment under CLIA healthcare providers obtain permission from the center of Medicare and Medicaid services to perform simple test, such as a urine pregnancy test in their office. These tests are known as CLIA waved test and are identified with the modifier QW.

 

“When the Doctor performed repeat test on same day at different time interval use modifier 91 for more than one test”

 

Note : In which case don’t use modifier 91  when test is repeated ———-

• Due to technician fault.
• For confirmation without physician order to repeat it.
• The repeat test is performed on the same specimen.

 

Panel Code CPT Guideline

 

Panel: A panel is a set of tests that are conducted together to asses a person’s overall health.

To bill for a panel, all these tests included in it must have been done if more than one panel is tested along with another test, only one panel can be billed and each additional test, will be billed separately.

 

For panel we have to follow rule while solving related to the panel topic:

• To code a panel Code like 80047, 80048, 80050, 80051 etc test must be done if single testing is missing than you have to code all tests separately.

 

• Don’t use 51 or 52 modifier with panel Code.

 

• Don’t report two or more panel codes that includes any of the same constituent test performed from the same patient collection.

 

• If more tests than those listed in the panel are performed, the panel is coded and additional tests are listed separately.

 

• If a group of tests overlaps two or more panel report the panel that incorporates the greater number of tests to fulfill the code definition and repeat the remaining test using individual test codes ( e.g don’t report 80047 in conjunction with 80053).

 

• The codes for each individual test are listed beside the test under each heading.

 

1. Consultation pathology codes 80503 – 80506, 88325,88333 don’t report E&M code with consultation pathology code.
2. Never multiply the drug class screening codes 80305, 80306, 80307.
3. When you find that in question is asking for pathologist at that time append 26 modifier with appropriate code.

 

Note : 26 modifier use for interpretation or reading (professional component) given in scenario.

Surgical pathology codes : 

For surgical pathology codes like 88300, 88302, 88305, 88307, 88309 these all codes we have to code based on the severity.

 

1. Number of specimen given in the scenario will be multiply with appropriate code like three specimen is given in the scenario at that time we have to code like 88305 X 3 . 88300 or 88305 we have to find as per scenario it’s for only reference.

 

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Pathology & Laboratory Series Questions CPT :- https://medicopediaa.com/pathology-laboratory-series-questions-cpt/

For Medical Coding Modifiers : https://medicopediaa.com/list-of-modifiers-used-in-cpt/

CPT Guidlines Anesthsia : https://medicopediaa.com/anesthesia-cpt-guidelines/

In this Article We Cover important guidelines of cpt Labs and Path —-

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