The Lab Maze: Navigating Basic Laboratory/Pathology Coding. Webinar Subscription Access Expires December 31.

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1 The Lab Maze: Navigating Basic Laboratory/Pathology Coding Questions Answers Webinar Subscription Access Expires December 31. How long can I access the on demand version? You will find that in the same instructions box you utilized to access this presentation. Subscription access expires December 31, individual purchases will not expire for at least two years. If you are the purchaser, you can find your information through following these steps: 1. Go to & login 2. Go to Purchases/Items 3. Click on Webinars tab 4. Click on Details next to the webinar 5. Find the instructions box in the middle of the page. Click on the link to the item you need (Presentation, MP3 file, Certificate, Quiz) Where can I ask questions after the webinar? The online member forums, where over 100,000 AAPC members have access to help each other with all types of questions. *Forum Posting Instructions* 1.Login to your online account 2.In the middle of the page you will see discussion forums 3.Click on view all top right hand side 4.Select general discussion under medical coding unless you see a topic that suits you more 5.On the top left side of the forum box, you will see a blue button, new thread click on that 6.Type your question and submit 7.Check back in that location for answers as you please

2 Hello, from the payer's perspective, is it reasonable to use codes 82486, 82491, and for monitoring of treatment? If so, how often? When a patient comes in for a screening colonoscopy and a biopsy is done, should the primary dx for the pathology be V76.51 to show that the procedure started as a screening or the diagnosis for the pathology result? Is there an age limit to bill for 87807? When billing codes 82486, 82491, and 82542, how many units are reasonable? We see billings in excess of 2 How do we know when to use instead of G0431? Client creates separate pathology/assession numbers for RT and LT specimens (ex breast). When charge is submitted they use multiple units. Understanding that there may be some payor specific guidelines, is it more appropriate to bill as multiple units? Or should the charge be submitted with modifier -RT and -LT as separate lines? There are actually 8 individual tests for In my opinion, yes. One of the purposes of lab is to monitor patients from the 'inside'. The how often would be a clinical call, and I don't even masquerade as a clinician. You would code the reason for the procedure (screening) as primary and the abnormal findings as secondary. Link the abnormal findings code to the biopsy specimen. Per CPT, there is no age limit. This is a disease most common in children, but can oocur in adults. It would depend on why they are running the test so many timees. It tis possible that they are running for different analytes, which would make it appropriate. If they are repeating due to lab error, they should not bill for the additional test. Medicare requires a G code for the drug screening, so this will come down to a payer issue. RT and LT would definitely make it clearer for the payer. As you mention though, this would be a carrier-specific call. You are correct...i couldn't count and speak at the same time!

3 We are getting insurances that are bundling separate test into the panel code. Example if we bill 4 out of the 7 test involved in the panel the pay us for the panel code. Have you heard of this happening? For reporting date of service. For quantatative testing performed in the physicians office do you report the the day the specimen was collected or can you report the day the specimen was actually tested. I acutally have heard of this, though I disagree. I would say that you should appeal to them with the CPT guidelines tha specify you can't report the panel unless all the tests are performed. It is my understanding that you report the date the specimen was tested. -- that was my original answer.now for the REAL answer: According to the Medicare Carrier's manual, the DOS is the date the specimen was collected. If the specimen is collected over a period of time, use the date the specimen collection ended. There are exceptions. You can find this information at Guidance/Guidance/Manuals/Downloads/clm104c16.pdf How would you code one specimen with performed in-house, as well as performed at an outside reference lab? Our contract states that we bill pass-through labs. You would need modifier on the reference lab code if you are not performing the test, but billing for it.

4 Is a modifier needed to bill with 88367? The is by PCR and is by FSH. I do not see a need for a modifier. I do not see a need for a modifier. We are getting denials from commercial insurances and Medicare stating is bundled with Sorry should have stated that first. A: Ah! There could be CCI edit on those then. Depending on the CCI, a modifier may be appropriate, but we'd have to look a the CCI to see how it is defined. Update: CCI does have bundled into Relative to 80101, it is our understanding that if a kit or dip stick, etc is used and a # of different drugs can be detected in one procedure, only one unit should be billed. Per the CPT Assistant, it would depend on the setup of the kit. If there are different views in the kit, then you would report for each. That doesn't mean that carriers won't have a different interpretation. Here's what CPT Assitant has to say: Question: If a patient is tested for opiates and barbiturates, how many times is code 80101, Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class, reported? For code 80101, each single drug class method tested and reported is to be counted as one drug class. If a sample is analyzed by five separate class-specific immunoassays and reported separately, code should be reported five times. Similarly, if a sample is run on a rapid assay kit composed of five classspecific immunoassays in a single kit, and the five classes are reported separately, code should again be reported five times.

5 For example, an obtunded patient comes to the emergency department with a history of possible drug abuse and the physician orders a drug screen for amphetamines, opiates, barbiturates, benzodiazepines, benzoylecgonine (cocaine), phencyclodine (PCP), and tetrahydocanabinol (marijuana). The laboratory performs single drug class screening for each analyte by means of immunoassay methods on a random access analyzer. Code would be reported seven times, because this code is used to report immunoassay and enzyme assay, single drug class methods. Seven units are reported as each single drug class is reported separately. If CMS has an MUE on = 2, wouldn't that mean you cannot bill more than 2? What did you mean by CMS using the Gap-Filled processed for molecular pathology codes? If there is an MUE, then that is a logical conclusion. It means they don't know how they are goign to price it. So they collected data from providers who opted to share cost informtion (to perform the test), then collected billing data for a period. They are reviewing the data collected and coming up with a fee schedule afterward.

6 Do you have any guidance for a payer regarding drug testing for patients on long-term opoids? For example, we have some providers billing extensive labs (83986; 83992; 94311; 82646; 82649; 83789; 83805; 83840; 83925; 81003; 82145; 82205; m 59; 82520; 82570; 80152; 80154; 80160; 80174; 80182; 80184) monthly or bimonthly for a majority of patients. Is there any guidance to show if this is accepted and/or medically necessary? This seems to be more of a clinical call, and I'm just a lab rat, not the mad scientist. I would suggest checking the specialty societies to see if they have any protocols for that. In what scenario can CPT 80500/80502 be used? Effective July 1, 2012, pathologist and independent laboratories that provide the technical (TC) of physician pathology services furnished to hospital patients may no longer bill for and received Medicare payment for these services. I am interrupting that to mean any and all codes having a technical component. Can you confirm and or elaborate on this. These are often seen with second opinion requests. A physcian may be asked to look at another report and offer an opinion of it's accuracy. The hospital is paid the TC, so the physician would not bill for that. The physician or lab would be paid by the hosptial as a separate contract. Are/Can 80500/80502 used for blood banks? When billing chemistry does moderate or high complexity come in to play when choosing codes. I'm not aware of any exclusion from those codes. I know there is an entire section for Transfusion Medicine, so you may want to check those first to see if there is something more appropriate. No the moderate and high complexity refers to the lab license.

7 When exactly should the code be used? If there are multiple breast samples as a result of the mastectomy can you quantity bill 88309? Can you use multiple units for Tier1 and Tier2 molecular pathology codes? How many units can be billed for if 2 blocks received for left breast biopsy 4:00 & 12:00 and 4 stains requested for each? Would this be 4 units per block? If you have two specimens but are using the same code such as 88305, would you use a -59 modifier on the second code? If the gene is not in the Tier 1 or Tier 2 list, you would use this unlisted code. If they are submitted as separate specimens for individual consideration. You may run into payer confusion thinking it's a duplicate, so would need to submit documentation to support the extra codes. I would need more information to accurately answer. On the surface, I would say no as most of these codes represent the full range of testing for those genes and include the specific numbers in some of the descriptions. According to CPT Assistant: CPT code 88342, Immunocytochemistry (including tissue immunoperoxidase), each antibody, may be reported one time for each antibody tested, and would be reported separately for each specimen. So yes, I would say 4 units per block. So, I actually conferred with a few other brains on this one. It boils down to CPT versus carrier preference. Per CPT, you should be fine simply reporting the units. As we know, payers may see it as duplicative, so the -59 would be a clue to a different specimen. It's even possible some would require a -76 (though we think it's unlikely).

8 For the and I found the edit, but am having trouble finding how it is defined. Any insight on code Erythropoietin? Medicare is denying as not a valid code for 2013 WOULD be used in dermatology? We need to have more information on the lab codes drug testing in pain management With regard to mod 91- if a different test is being performed, but they are billed with the same CPT, would modifier 91 be added to the second test? is a component of Meaning when you perform 81235, you perform as part of it. so no, you would not report both, you would only report the It is still valid in CPT. I can find FL Medicare reimbursement data, so I'm not sure what the issue is. I'm not sure I completely follow the intent here is a pathologist code. Dermatologist wouldn't usually report this, unless of course your dermatologist is also acting as pathologist, in which case the MOH's surgery codes may be more appropriate. That's a pretty broad request. I know that drug testing/screening is an important part of any pain parctice. Other than the information covered about screening and confirmation codes, what other information are you looking for? AAP knows how to get with me if there is something more specific to address here. Modifier -91 indicates a repeat test, inferring that it's to obtain multiple test results. If it's a different speciment all together, modifier -59 may be appropriate. This comes down to a carrier preference as from a CPT perspective, you could just code the number of units.

9 From the payor side, when billing aliquots of blood can dividing doses, aliquots and the orig unit of blood all be billed? Hi can you advise cpt code had been deleted, thank you. Please explain chromatographic method. Can you please clarify diagnosis for a patient with elevated blood sugar but physician did not state uncontrolled diabetes - can we code uncontrolled What is the chromatographic method? Can we use a diagnosis from the previous labs on a current lab test? The aliquots are to aid in maintaining the viability of the specimen. The only billing should be on the individual test performed, and not on the number of aliquots. IF an aliquot is used to perform a different test, or repeat a test, then yes it would be appropriate. If the aliquot is used due to lab error on QA, then no it should not be billed. Yes, have been deleted. To report, see It's a specific technique used the lab to perform the test by separating the specimen into it's chemical compounds. If you are unsure of the method, the best bet is to check with the lab to see if they are utilizing this method before assigning the code. Elevated blood sugar does not equate uncontrolled diabetes. It needs to be stated as such. It's a specific technique used the lab to perform the test by separating the specimen into it's chemical compounds. If you are unsure of the method, the best bet is to check with the lab to see if they are utilizing this method before assigning the code. I wouldn't do that.

10 On the consultation codes through how do you know the quantity to bill? Is it per specimen? So if you get 5 slides can you bill 5 times or only once? These are per 'case', so no matter how many slides, they are reported once per case. Is there a modifier required for CPT 82948? Medicare has been dening Is there a modifier required for CPT 82948? Medicare has been denin In the case of in house labs that are using the machine to analyze the analytes for drug testing what is the number of drug classes to be used on 80101? But the code says that you can only use this for the drug classes, so if you have patients that are drug addicted aren't there only 10 drug classes? Do in house labs that use a machince to analyze analyytes (quantative) do we use or the chemistry coding set. If you are billing code Gammaglobulin; IG Sorry IGA, IGD, IGG, IGM each do you bill in units or with a modifier? Further define case...for example the 5 slides that were sent for consultation, this would only be a quantity of 1. Are you a physician's office? It might be that you need the QW modifier to show Clia Waived test. Are you a physician's office? It might be that you need the QW modifier to show Clia Waived test. It would depend on the number of analytes being tested. Correct, it is per drug class. There's actually a table in the Professional edition of CPT on page 414 that breaks down drug screening codes. You may find it helpful for the screening sounds more appropriate. I would say units, but as in other discussion topics here, it may be necessary (depending on the carrier) to report a modifier. I would say units, but as in other discussion topics here, it may be necessary (depending on the carrier) to report a modifier. If it's one patient and disease, that's a case. In your example, one unit seems appropriate.

11 Can you please advise on the following - physician sees patient and suspects hyperlipidemia. Sign/symptom is dizzy. The lab comes back the next day positive for hyperlipidemia. Can we use that diag on the visit as well as the lab or are we correct in coding sign/symptom until physician confirms on next visit? If you have pathological confirmation documented in the record, then you could use that diagnosis. Is there any diagnosis code for elevated BNP and positive d dimer? So does that mean is appropriate for both qualitative and quantitative testing? There's some good discussion on this on the AAPC forums. For elevated BNP, it appears is the consensus. Here's a link to one on the d-dimer coding: No, is qualitative (is it there?) only. Quantitative test are in the Assay section of codes.