CPC - Certified Professional Coder Radiology and Pathology Coding Questions and Answers 1 — Questions and Answers
Question 1: A patient is sent to a hospital's outpatient radiology department for a chest x-ray. The order specifies PA and lateral views. A radiologist who is not employed by the hospital provides the official interpretation and report. Which CPT® code(s) and modifier(s) should the radiologist report?
- 71046-TC
- 71045
- 71046-26 (Correct answer)
- 71046
Correct answer: 71046-26
CPT® code 71046 represents a radiologic examination of the chest with two views. Since the radiologist only provided the professional component (the interpretation and report) and did not own the equipment or employ the technologist, modifier -26 (Professional Component) must be appended. Modifier -TC would be used by the facility for the technical component. 71045 is for a single view.
Question 2: A pathologist receives a specimen labeled 'total colectomy for adenocarcinoma.' The pathologist performs a gross and microscopic examination of the entire colon. Which CPT® code series is used to report this service?
- 88309 (Correct answer)
- 88173
- 88342
- 88005
Correct answer: 88309
The 88300-88309 series represents Surgical Pathology services, which are assigned based on the complexity of the specimen. A total colectomy is a complex specimen, typically categorized under Level VI, making 88309 the appropriate code. 88173 is for Cytopathology (e.g., Pap test interpretation), 88342 is for immunohistochemistry, and 88005 is for a postmortem examination.
Question 3: A patient undergoes a CT scan of the abdomen with IV contrast and a CT scan of the pelvis without IV contrast during the same encounter. Which of the following is the correct way to report these services?
- Report the combination code for CT abdomen and pelvis with contrast.
- Report the CPT® code for CT abdomen with contrast and the CPT® code for CT pelvis without contrast separately. (Correct answer)
- Report only the CT of the abdomen with contrast as it is the more comprehensive service.
- Report the combination code for CT abdomen and pelvis without contrast and add a code for contrast administration.
Correct answer: Report the CPT® code for CT abdomen with contrast and the CPT® code for CT pelvis without contrast separately.
When CT scans of contiguous body areas are performed with different contrast specifications (one with, one without), the combination codes (e.g., 74176, 74177) cannot be used as they describe scenarios where both areas are with, without, or both with and without contrast. The correct method is to code each study individually: 74160 (CT, abdomen; with contrast) and 72192 (CT, pelvis; without contrast).
Question 4: Which of the following services is reported using a code from the clinical pathology section, specifically the Organ or Disease-Oriented Panels (80047-80081)?
- Gross and microscopic examination of a skin biopsy
- Comprehensive Metabolic Panel (Correct answer)
- Interpretation of a chest X-ray
- Fine needle aspiration of a cyst
Correct answer: Comprehensive Metabolic Panel
The Organ or Disease-Oriented Panels (80047-80081) are a specific subsection of the Pathology and Laboratory CPT® codes. The Comprehensive Metabolic Panel (80053) is a common example from this section. Skin biopsy examination falls under surgical pathology (88300 series), chest X-ray interpretation is radiology (70000 series), and fine needle aspiration is a surgical procedure (10000 series).
Question 5: A physician performs a fine needle aspiration (FNA) biopsy of a single, deep lymph node in the neck. The procedure is performed using ultrasonic guidance for needle placement, which is documented with permanently recorded images. How should this encounter be coded?
- Report only the code for the FNA biopsy.
- Report the code for the FNA biopsy and the code for the ultrasonic guidance separately. (Correct answer)
- Report only the code for the ultrasonic guidance.
- Report a single comprehensive code that includes both the FNA and the guidance.
Correct answer: Report the code for the FNA biopsy and the code for the ultrasonic guidance separately.
CPT® guidelines require separate reporting for the biopsy procedure and the imaging guidance used to perform it. The coder should report 10005 (Fine needle aspiration biopsy, including ultrasound guidance; first lesion) for the FNA itself, which now includes the guidance. An older rule would have been a code like 10021 for the FNA and 76942 for the ultrasound guidance. However, CPT® codes were updated to bundle these services. 10005 is the correct code for an FNA with US guidance of the first lesion.
Question 6: What is the primary distinction between the global, professional, and technical components in radiology coding?
- The type of imaging modality used (e.g., X-ray vs. MRI).
- The complexity of the procedure and the patient's condition.
- Whether the service includes both the performance of the imaging and the physician's interpretation, or only one of those parts. (Correct answer)
- The anatomical location being imaged.
Correct answer: Whether the service includes both the performance of the imaging and the physician's interpretation, or only one of those parts.
The global service includes both the technical component (TC - use of equipment, supplies, technologist) and the professional component (26 - physician's interpretation and report). When these components are provided by different entities (e.g., a hospital provides the TC and an independent radiologist provides the 26), they are billed separately using the appropriate modifiers. The imaging modality and anatomy determine the CPT® code, not the component.
CPC - Certified Professional Coder Radiology and Pathology Coding Questions and Answers 1
A patient is sent to a hospital's outpatient radiology department for a chest x-ray.
The order specifies PA and lateral views.
A radiologist who is not employed by the hospital provides the official interpretation and report.
Which CPT® code(s) and modifier(s) should the radiologist report?