AAPC - American Academy of Professional Coders Pathology and Laboratory Codes Questions and Answers — Questions and Answers
Question 1: A physician orders a Comprehensive Metabolic Panel (CPT 80053). Due to a clotted specimen, the laboratory is unable to perform the total protein test, but all other 13 components of the panel are completed successfully. How should the laboratory bill for this service?
- Bill for the individual CPT codes for the 13 tests that were performed. (Correct answer)
- Bill for the Comprehensive Metabolic Panel (80053) with modifier 52 for reduced services.
- Bill for the Basic Metabolic Panel (80048) and the additional individual tests performed.
- Do not bill for any services, as the ordered panel was incomplete.
Correct answer: Bill for the individual CPT codes for the 13 tests that were performed.
According to CPT guidelines for Organ or Disease-Oriented Panels, if any component of a panel is not performed, the coder must not use the panel code. Instead, each individual test that was successfully completed should be reported with its own CPT code. Modifier 52 is not appropriate for incomplete lab panels, and billing a different panel plus add-on tests is incorrect if that combination does not accurately represent the services ordered and rendered.
Question 2: A pathologist performs a gross and microscopic examination of a colon biopsy specimen taken during a colonoscopy. What is the appropriate CPT code for this service?
- 88302 - Level II - Surgical pathology, gross and microscopic examination
- 88309 - Level VI - Surgical pathology, gross and microscopic examination
- 88305 - Level IV - Surgical pathology, gross and microscopic examination (Correct answer)
- 88300 - Level I - Surgical pathology, gross examination only
Correct answer: 88305 - Level IV - Surgical pathology, gross and microscopic examination
CPT code 88305 is designated as Level IV surgical pathology, which includes the gross and microscopic examination of specific specimen types. The CPT manual explicitly lists "Colon, biopsy" as an example of a specimen appropriate for code 88305. Code 88302 is for less complex specimens, 88309 is for highly complex specimens like a total colectomy, and 88300 is for gross examination only without microscopy.
Question 3: A urine specimen is sent to the lab for a suspected urinary tract infection. The lab performs a culture with a colony count, which is positive. Subsequently, a sensitivity study is performed on the isolated organism to determine antibiotic effectiveness. Which of the following is the correct way to code these services?
- Report one comprehensive code that bundles culture and sensitivity.
- Report the CPT code for the definitive identification of the organism only.
- Report the CPT code for the culture and, if performed, a separate CPT code for the sensitivity study. (Correct answer)
- Report the CPT code for urinalysis with reflex to culture.
Correct answer: Report the CPT code for the culture and, if performed, a separate CPT code for the sensitivity study.
In microbiology coding, the initial culture (e.g., CPT 87086 for a quantitative culture) is reported first. If the culture is positive and a medically necessary sensitivity study is performed, the sensitivity study (e.g., 87184) is reported as a separate and additional service. There is no single CPT code that bundles a urine culture with a sensitivity study; they are distinct procedures.
Question 4: Which of the following services is an example of a presumptive drug test?
- A quantitative test using gas chromatography-mass spectrometry (GC-MS) to identify a specific drug and its concentration.
- A qualitative immunoassay test using a dipstick or cup that is read by direct optical observation. (Correct answer)
- A therapeutic drug assay to monitor the level of a prescribed medication.
- A molecular pathology test to identify genetic markers for drug metabolism.
Correct answer: A qualitative immunoassay test using a dipstick or cup that is read by direct optical observation.
Presumptive drug tests (CPT codes 80305-80307) are used to detect the presence or absence of a drug class and yield a qualitative result (positive or negative). CPT 80305 specifically describes tests, such as dipsticks or cups, read by direct optical observation. Definitive tests (like GC-MS) provide quantitative results, therapeutic assays monitor prescribed drugs, and molecular tests analyze genes.
Question 5: An attending physician is perplexed by a patient's conflicting lab results and requests a formal consultation from the hospital pathologist. The pathologist reviews the patient's medical records and laboratory data, and provides a comprehensive written report with their medical interpretive judgment. Which CPT code series would be used to report this service?
- 88321-88325 (Consultation and report on referred slides prepared elsewhere)
- 99242-99245 (Office or Other Outpatient Consultations)
- 88300-88309 (Surgical Pathology)
- 80503-80506 (Pathology Clinical Consultation) (Correct answer)
Correct answer: 80503-80506 (Pathology Clinical Consultation)
The CPT code range 80503-80506 is specifically designated for pathology clinical consultations. These codes are used when a pathologist, upon the request of another physician, renders a medical interpretive judgment and provides a written report based on a review of patient records and lab findings, without evaluating a new specimen. The 88321 series is for reviewing slides from another institution, 99242-99245 involves face-to-face patient evaluation, and the 88300 series is for the examination of tissue specimens.
Question 6: During the examination of a gastric biopsy (coded as 88305), the pathologist finds it medically necessary to perform an additional special stain to detect the presence of Helicobacter pylori microorganisms. How should this additional service be coded?
- It is included in the primary surgical pathology code (88305) and not reported separately.
- With an add-on CPT code for a special stain for microorganisms, such as 88312. (Correct answer)
- By appending modifier 22 (Increased Procedural Services) to the 88305 code.
- With a separate CPT code for immunohistochemistry, such as 88342.
Correct answer: With an add-on CPT code for a special stain for microorganisms, such as 88312.
Special stains are not included in the base surgical pathology codes (88300-88309). CPT code 88312 is used to report a Group I special stain for microorganisms (like H. pylori) and is reported in addition to the primary code for the surgical pathology examination. Modifier 22 would be inappropriate, and immunohistochemistry (88342) is a different type of staining procedure.
AAPC - American Academy of Professional Coders Pathology and Laboratory Codes Questions and Answers
A physician orders a Comprehensive Metabolic Panel (CPT 80053).
Due to a clotted specimen, the laboratory is unable to perform the total protein test, but all other 13 components of the panel are completed successfully.
How should the laboratory bill for this service?