Ch. 18 Path and Lab Flashcards
What does “in vivo” mean?
c. in the living body
Response Feedback:
Rationale: In vivo means “in the living body” and is used to describe studies to analyze blood components, percutaneously obtained, in the body.
What is the code for gross and microscopic examination (surgical pathology) of breast tissue from a simple mastectomy?
c.
88307
Response Feedback:
Rationale: In the CPT® Index, look for Pathology and Laboratory/Surgical Pathology/Gross and Micro Exam. Review the specimens within each of the levels to determine the correct code. There are a number of codes for examination of breast tissue. The coder must be careful to choose the code describing the exact specimen received. Simple mastectomy is listed under 88307.
HCPCS Level II codes specifically for Pathology and Laboratory services all start with what letter?
b. P
Response Feedback:
Rationale: In the HCPCS codebook, P2028-P9615 report Pathology and Laboratory Services including chemistry, toxicology and microbiology tests, screening Pap procedures and various blood products.
A patient has a severe traumatic fracture of the humerus. During the open reduction procedure, the surgeon removes several small pieces of bone embedded in the nearby tissue. They are sent to Pathology for examination without microscopic sections. The pathologist finds no evidence of disease. How should the pathologist code for his services?
c.
88300
Response Feedback:
Rationale: In the CPT® Index, look for Pathology and Laboratory/Surgical pathology/Gross Exam/Level I directing you to 88300. Examination without microscopic sections is coded 88300 for all types of specimens. Code 88304 includes both gross and microscopic exam.
A patient with abnormal growth had a suppression study that included 4 glucose tests and 4 human growth hormone tests. What CPT® code(s) is/are reported?
d.
80430, 82947
Response Feedback:
Rationale: Use the Evocative/Suppressive panel codes whenever all of the tests in the panel are performed. If extra tests are performed, these should be coded separately. In the CPT® Index, look for Growth Hormone/Growth Hormone Suppression Panel. Code descriptor for code 80430 indicates this should include Glucose (82947 x 3) and Human growth hormone (HGH) (83003 x 4). There were 4 glucose tests performed. Look in the CPT® Index, look for Glucose/Blood test. Code 82947 is reported for the 4th test.
A 35 year-old type II diabetic is feeling weak. The physician performs a stat glucose test in which a finger stick is done placing the drop of blood on a reagent strip. The test indicates the patient is hypoglycemic. The physician gives the patient some glucose supplements and performs another stat glucose test using the same lab test as before 30 minutes later. The second test shows the glucose levels returned to normal. How are the lab tests reported?
b.
82948, 82948-91
Response Feedback:
Rationale: Look in the CPT® Index for Glucose/Blood Test referring you to codes 82947, 82948, 82950. The lab test used a reagent strip for the glucose test reporting code 82948. Modifier 91 is the correct modifier to use when the same laboratory test is repeated on the same day for a subsequent result.
A cardiac patient must take digoxin to treat his atrial fibrillation (Afib). This condition has been controlled for several years but the patient now presents to his physician with new complaints of irregular heartbeats. The physician orders a total digoxin study to determine the total level of digoxin in order to measure the drug’s efficacy in treating his Afib. What CPT® code is reported?
d.
80162
Response Feedback:
Rationale: This test is a therapeutic drug assay and should be coded in that section of the chapter. 80162 is used for a total digoxin level. Look in the CPT® Index for Therapeutic Drug Assay/Digoxin and you are directed to 80162, 80163. Verification of this code confirms code selection.
A patient has a traumatic head injury and some cerebrospinal fluid (CSF) is removed to limit potential damage from swelling of the brain. The CSF is sent to pathology for examination and the results show unusual cytological counts, although no specific findings. The patient has had no previous symptoms known to his family members. What is the ICD-10-CM code for this examination of CSF?
c.
R83.6
Response Feedback:
Rationale: In the ICD-10-CM Index to Alphabetic Index, look for Abnormal/cerebrospinal fluid/cytology referring you to R83.6. Verification in the Tabular List confirms code. Code R83.6 is used to describe non-specific abnormal findings on examination of CSF. If the patient had previously identified disease or symptoms or if the study findings are definitive for a specific disease process, that would have been coded instead.
If the findings on examination of a Pap smear are normal and described as “negative for intraepithelial lesion or malignancy” this is an example of what type of results reporting?
d. Bethesda
Response Feedback:
Rationale: This is an example of reporting by the Bethesda method. In the CPT® Index, look for Bethesda System referring you to 88164-88167. On the page before this code range, read the Guidelines where it discusses the Bethesda & non-Bethesda reporting of Pap smears.
A patient has a cholecystectomy and a soft tissue lipoma removed during the same operative session. Both specimens were sent to pathology in separate containers are examined by the pathologist. What CPT® code(s) are reported?
c.
88304 x 2
Response Feedback:
Rationale: In the CPT® Index, look for Pathology and Laboratory/Surgical Pathology/Gross and Micro Exam. Under Gross and Micro Exam, Levels II-VI are listed. Read these codes to determine the correct code. Both of these specimens (gallbladder and soft tissue lipoma) are coded under 88304. Sometimes it is helpful to know the names of surgical procedure to select the correct pathology code. A cholecystectomy is excision of the gallbladder.
A patient presents with right upper quadrant pain, nausea and other symptoms of liver disease as well as complaints of decreased urination. Her physician orders an albumin; bilirubin, both total and direct; alkaline phosphatase; total protein; alanine amino transferase; aspartate amino transferase, and creatinine. What CPT® code(s) is/are reported?
c.
80076, 82565
Response Feedback:
Rationale: The patient was being tested for symptoms of liver disease, hepatic. Look in the CPT® Index for Blood Tests/Panels/Hepatic Function referring you to 80076. Also, see Creatinine/Blood referring you to 82565. Code the laboratory panel anytime all of the tests listed in the panel are completed. If additional tests are also performed, they are coded separately.
Mr. Bowen is having a pre-employment physical (screening). His doctor ordered the following serum blood tests: CBC, automated, automated differential WBC, comprehensive metabolic panel and a thyroid stimulating hormone (TSH) assay. Code the services for these labs.
b.
80050
Response Feedback:
Rationale: Look in the CPT® Index for Blood Tests/Panels/General Health referring you to 80050. Guidelines in the Organ or Disease-Oriented Panels section state, “The tests listed with each panel identify the defined components of that panel. ” The CBC, automated and automated differential WBC, and TSH are part of the general health panel and are not coded separately.
A patient arrives at to the ED. It appears the patient has been suffering from periods of disorientation, persistent stomachache, fatigue, over the past several months but the persistent patch of dark skin that appeared on the patient’s chest has prompted his visit. The treating ED physician orders a stimulation panel for adrenocorticotropic hormone (ACTH) consisting of two cortisol injections, 60 minutes apart. Blood tests reveal ACTH levels are at 300 nmol/L, and diagnoses the patient with adrenal insufficiency. What CPT® codes are reported for the lab services?
d.
80400
Response Feedback:
Rationale: Each cortisol injection is included in the ACTH Stimulation Panel. Looking in the CPT® Index under Evocative/Suppression Test referring you to 80400-80439. There is a note to also See Pathology and Laboratory, Evocative/Suppression Test. Look for Pathology and Laboratory/Evocative/Suppression Test/ Stimulation Panel/ACTH. Reviewing the codes, confirms the only code that applies to and ACTH Stimulation Panel is 80400.
A patient will be undergoing a transplant and needs HLA tissue typing with DR/DQ multiple antigen and lymphocyte mixed culture. How will these services be coded?
b.
86817, 86821
Response Feedback:
Rationale: In the CPT® Index look for Tissue/Typing/Human Leukocyte Antigen (HLA)/Antibodies. Code 86817 is the correct code to report for HLA tissue typing with DR/DQ. Then, look in the CPT® Index for Tissue/Typing/Lymphocyte Culture referring you to code 86821. Codes 86805 and 86806 are for lymphocytotoxicity, not lymphocyte mixed culture.
What is the CPT® coding for thawing 4 units of fresh frozen plasma?
d.
86927 x 4
Response Feedback:
Rationale: In the CPT® Index, look for Plasma/Frozen Preparation and you are directed to 86927. Code 86927 is specifically for plasma rather than whole blood. The code is used per unit with 86927 x 4 as correct.
