CPC Chapter 18- Pathology/Laboratory Review Questions

Question 1

The word “pathology” refers to the study of which of the following?
A. Deterioration
B. Direction
C. Disease
D. Distress

Answer 1

C. Disease

Rationale: The root word path means “disease.” The suffix -logy is “study of.”

Question 2

Which word describes the study of small life forms?
A. Hematology
B. Immunology
C. In vivo
D. Microbiology

Answer 2

D. Microbiology

Rationale: The root words micro (small) and bio (life) combined with the suffix -logy describe the study of small life forms.

Question 3

Which term is used with the word pathologist to describe someone specializing in legal or investigational studies?
A. In vivo
B. Forensic
C. Laboratory
D. None of the above

Answer 3

B. Forensic

Rationale: The word forensic refers to information related to an investigation of legal matters. A forensic pathologist examines specimens for causes of disease or death related to legal matters.

Question 4

A test determining the presence or absence of a substance is considered what type of test?
A. Qualitative
B. Quantitative
C. Forensic
D. Hematologic

Answer 4

A. Qualitative

Rationale: A qualitative test determines the presence or absence of the substance.

Question 5

If a patient has a test result indicating a blood alcohol level of .05, what type of test was performed to determine this information?
A. Microbiology
B. Qualitative
C. Quantitative
D. Urine dip test

Answer 5

C. Quantitative

Rationale: A quantitative test determines the amount of a substance found in the specimen. A qualitative test determines the presence or absence of the substance.

Question 6

A patient has been exposed to rabies. He has no signs or symptoms of infection. A test is performed to check for rabies in his blood. What code describes the necessity for the test?
A. Z23
B. B97.89
C. Z20.3
D. A82.9

Answer 6

C. Z20.3

Rationale: The codes in category Z20 are for exposure/contact to a disease without signs or symptoms of infection. Look in the ICD-10-CM Alphabetic Index for Exposure (to)/rabies Z20.3.

Question 7

A woman has identified a lump in her right breast. After examination, the physician decides a biopsy is indicated. A specimen is sent for pathologic examination. The finding is carcinoma of the breast in the upper inner quadrant. What diagnosis is assigned for the pathologic examination?
A. N63.12
B. C80.1
C. C50.211
D. Z01.419

Answer 7

C. C50.211

Rationale: Always code the most specific diagnosis known. When a diagnosis of carcinoma of the breast has been confirmed, it is inappropriate to code a less specific diagnosis, no matter the reason for the original test. In the ICD-10-CM Alphabetic Index, look for Carcinoma (malignant) (see also Neoplasm, by site, malignant). Go to the Table of Neoplasms, and look for Neoplasm, neoplastic/breast/upper inner quadrant/Malignant Primary (column) C50.2-. Verification in the Tabular List indicates that six characters are needed to complete the code. Report C50.211 for the upper inner quadrant of the right breast.

Question 8

A patient with rheumatoid arthritis takes nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain. He also has regular blood tests to monitor kidney function due to his long-term use of the NSAIDs. What diagnosis coding describes the need for the test when the results are normal (the patient has no symptoms of liver disease)?
A. Z79.1, Z51.81
B. M06.9, Z79.1, Z51.81
C. M06.9
D. Z79.1, M06.9

Answer 8

B. M06.9, Z79.1, Z51.81

Rationale: Code both arthritis and the long-term use of NSAIDs. Look in the ICD-10-CM Alphabetic Index for Arthritis/rheumatoid, directing you to M06.9. For the next code, look for Therapy/drug, long term (current) (prophylactic)/anti-inflammatory directing you to Z79.1. There is an instructional note under category code Z79 to report also any therapeutic drug level monitoring with code Z51.81. This is found in the Alphabetic Index by looking for Monitoring (encounter for)/therapeutic drug level Z51.81. Verify these codes in the Tabular List and read any instructions provided.

Question 9

A patient has a history of prostate cancer with removal of the prostate and has completed radiation therapy with no recurrence for two years. A PSA is performed to check for any recurrence. The results show a PSA within normal limits. What diagnosis code(s) describe(s) this test?
A. C61
B. Z08, Z85.46, Z91.79
C. Z12.5
D. Z00.00

Answer 9

B. Z08, Z85.46, Z90.79

Rationale: Per ICD-10-CM coding guideline I.C.21.c.8 follow-up codes are used to explain continuing surveillance following completed treatment of a disease, condition, or injury. They imply that the condition has been fully treated and no longer exists. The follow-up code is sequenced first followed by the history code. Look in the ICD-10-CM Alphabetic Index for Examination/follow-up (routine) (following)/radiotherapy NEC/malignant neoplasm directing you to Z08. Once cancer has been excised and there is no further treatment directed toward the cancer site without recurrence, choose a personal history of malignancy code. Look for History/personal (of)/malignant neoplasm (of)/prostate directing you to Z85.46. Confirm codes in the Tabular List. According to AHA Coding Clinic (2000 Vol. 17 No.4) screening codes are not used for patients who have any sign or symptom of a suspected condition or history of a condition. The instructional note in the Tabular List for Z08 indicates to use additional code to identify any acquired absence of organs (Z90.-). Look in the Alphabetic Index for Absence/prostate (acquired), referring you to Z90.79.

Question 10

A woman comes in for her annual exam with a cervical Pap smear. The results are abnormal, although they are not diagnostic of any specific disease. A second Pap smear is obtained, and this test identifies only normal cells. What diagnosis code identifies the medical necessity for the second Pap smear?
A. N92.6
B. N92.3
C. N92.4
D. R87.619

Answer 10

D. R87.619

Rationale: Choose a code that identifies unspecified previous abnormal findings on cervical Pap smear. Although the second test results came back normal, the previous abnormal finding supports the need for a repeat test. Look in the ICD-10-CM Alphabetic Index for Findings, abnormal, inconclusive, without diagnosis/Papanicolaou cervix, directing you to R87.619. Verify this code in the Tabular List.

Question 11

A patient with deep vein thrombosis requires heparin to maintain therapeutic anticoagulation levels. He has regular PTTs drawn to monitor his level of anticoagulation. What code describes this testing?
A. 85730
B. 85520
C. 80299
D. None of these

Answer 11

A. 85730

Rationale: PTT stands for partial thromboplastin time. Look in the CPT® Index for PTT/Partial Thromboplastin Time (PTT) referring you to 85730-85732. Checking the listing, 85730 Thromboplastin time, partial (PTT); plasma or whole blood is the correct code for this test.

Question 12

What is the code and any required modifier(s) for dipstick urinalysis, non-automated, without microscopy performed in a physician office for a Medicare patient?
A. 81025-26-QW
B. 81002-26-QW
C. 81002-QW
D. 81002

Answer 12

D. 81002

Rationale: 81002 is for dipstick urinalysis. Modifier 26 is not needed in the physician office. Code 81002 is a CLIA-waived test but is one of the codes that does not require modifier QW. Look in the CPT® Index for Urinalysis/Routine.

Question 13

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. How should this be coded?
A. 82040, 82247, 82248, 84075, 84155, 84460, 84450, 82565
B. 80076, 82565
C. 80076
D. 80076-22

Answer 13

B. 80076, 82565

Rationale: Code the panel when all the tests listed in the panel are completed. If additional tests are also performed, they are coded separately. The first 7 tests are all listed in code 80076. This leaves creatinine, which is reported with code 82565. Look in the CPT® Index for Blood Tests/Panels/Hepatic Function and you are directed to 80076. Next, look for Creatinine/Blood directing you to 82565. Verify these codes.

Question 14

A 27-year-old male dies of a gunshot wound. An autopsy is performed to gain evidence for the police investigation and any subsequent trial. What code describes this service?
A. 88005
B. 88025
C. 88040
D. 88045

Answer 14

C. 88040

Rationale: Services related to legal investigations and trials are forensic examinations. Look in the CPT® Index for Autopsy/Forensic Exam, and you are directed to 88040. Read the code to verify this as the correct listing.

Question 15

A patient with Acquired Immune Deficiency Syndrome (AIDS) presents for follow-up care. A total T-cell count is ordered to evaluate progression of the disease. What is the correct code(s) for this study?
A. 86703
B. 86360
C. 86361, 86359
D. 86359

Answer 15

D. 86359

Rationale: Code 86359 is for total T-cell count. If other studies were performed, they were not ordered and may not be billed, no matter how seemingly appropriate. Look in the CPT® Index for T-Cells/Count, which directs you to 86359.

Question 16

A patient presents with worries she is at risk for cancer. She asks for tests to verify whether she has cancer. The test comes back normal. What type of service is this considered?
A. Screening services
B. Abnormal findings
C. Signs and symptoms
D. Cancer

Answer 16

A. Screening services

Rationale: Services performed when there are no symptoms and returning normal results are considered screening services.

Question 17

Tests in the Chemistry section of CPT® are what types of tests unless specified otherwise?
A. Semi-quantitative
B. Surgical
C. Qualitative
D. Quantitative

Answer 17

D. Quantitative

Rationale: The codes in the Chemistry section (82009-84999) identify how much of a substance is present in the specimen. According to the guidelines, “The examination is quantitative unless specified.”

Question 18

What does “in vivo” mean?
A. necropsies
B. maternal
C. fetal
D. in the living body

Answer 18

D. in the living body

Rationale: In vivo means “in the living body” and is used to describe studies to analyze blood components, percutaneously obtained, in the body.

Question 19

What modifier must always be applied to Medicare claims for tests performed in a site with a CLIA Waived certificate?
A. 90
B. QW
C. 91
D. 26

Answer 19

B. QW

Rationale: Medicare requires that the QW modifier be applied for all claims for payment of test performed in a site with a CLIA waived certificate. If the location does not have a certificate, the service should not be billed, and it should not be performed. Modifier QW is found in the HCPCS Level II codebook.

Question 20

What modifier identifies the professional component of a service?
A. 91
B. PC
C. TC
D. 26

Answer 20

D. 26

Rationale: Modifier 26 identifies the Professional component. Modifier TC identifies the technical component. There is no modifier PC. The HCPCS Level I modifiers are listed in the CPT® code book in Appendix A and the HCPCS Level II modifiers are listed in the HCPCS code book.

Question 21

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?
A. 80430
B. 80430, 82947, 83003
C. 80430, 82947
D. 82947 X4, 83003 X4

Answer 21

C. 80430, 82947

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.

Question 22

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?
A. 80076
B. 80076-22
C. 80076, 82565
D. 82040, 82247, 82248, 84075, 84155, 84460, 84450, 82565

Answer 22

C. 80076, 82565

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.

Question 23

A pregnant patient is tested for serologic blood type and Rh factor. What CPT® code(s) are reported?
A. 86920, 86906
B. 86900
C. 85060
D. 86900, 86901

Answer 23

D. 86900, 86901

Rationale: Patient is getting two different lab tests. The first lab test is to determine if the patient has O, A, B or AB blood type. In the CPT® Index, look for Blood Typing, Serologic/ABO Only which directs you to code 86900. The second lab test is to determine if the patient is negative or positive for the Rh antigen. For the Rh factor, look in the CPT® Index for Blood Typing, Serologic/Rh (D), which directs you to 86901.

Question 24

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?
A. 82947, 82947-76
B. 82948, 82948-76
C. 82947, 82947-91
D. 82948, 82948-91

Answer 24

D. 82948, 82948-91

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.

Question 25

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?
A. This service cannot be billed
B. 88309, 88311
C. 88300
D. 88304

Answer 25

C. 88300

Rationale: In the CPT® Index, look for Surgical Pathology/Gross and Microscopic Exams/Level I referring to 88300. Examination without microscopic sections is coded 88300 for all types of specimens. Code 88304 includes both gross and microscopic exam.

Question 26

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?
A. R83.6
B. A39.0
C. Z00.01
D. S06.1X0A

Answer 26

A. R83.6

Question 27

A patient with AIDS presents for follow up care. The total T-cell count is ordered to evaluate any progression of the disease. What CPT® code(s) is/are reported?
A. 86360
B. 86703
C. 86359
D. 86361, 86359

Answer 27

C. 86359

Rationale: In the CPT® Index, look for T Cells/Count. Code 86359 is for total T-cell count. If other studies were performed and they were not ordered they may not be billed, no matter how seemingly appropriate.

Question 28

What is usually found in the blood if a person has or used to have an infecting virus?
A. Antigen
B. Allergen
C. Antibody
D. None of the above

Answer 28

C. Antibody

Rationale: Antibodies remain in the blood long after the antigen (the substance that causes antibodies to form) may be gone.

Question 29

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?
A. 88304 X2
B. 88304, 88302
C. 88305 X2
D. 88305, 88304

Answer 29

A. 88304 X 2

Rationale: In the CPT® Index, look for Surgical Pathology/Gross and Microscopic Exams; Levels I-VI are listed. Read these codes to determine the correct code. Both 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.

Question 30

A patient has a cytopathology study performed by a fine needle aspiration. The results are quite unusual and are considered moderately complex. The slides as well as a copy of pertinent information from the patient’s record are sent to another cytopathologist for consultation. The consulting pathologist reviews the slides and reviews the patient’s chart material. A report is sent back to the original pathologist with the findings. The medical decision making is considered moderate. What CPT® code is reported?
A. 80505
B. 80504
C. 80503
D. 99245

Answer 30

B. 80504

Rationale: In the CPT® Index, look for Consultation/Clinical Pathology. This will lead to codes 80503-80506. The clinical problem is of moderate complexity, there is review of patient’s history and medical record, and level of medical decision making is moderate, leading to code 80504. The E/M consultation codes require a face-to-face encounter with the patient.

Question 31

A couple has been trying to conceive for nine months without success. Preliminary studies show the woman ovulates and the husband’s sperm count is good. A sperm sample is submitted for both a post coital Huhner test and a hamster penetration test. Report the codes.
A. 89310, 89330
B. 89300, 89329
C. 89325, 89260
D. 89300, 89320

Answer 31

B. 89300, 89329

Rationale: Look in the CPT® Index for Huhner Test/Semen Analysis. The post coital test is described by code 89300. The second test ordered and performed on the sperm sample is a hamster penetration test. Look in the CPT® Index for Hamster Penetration Test/Sperm Evaluation referring you to code 89329.

Question 32

A patient’s mother and sister have been treated for breast cancer. She has blood drawn for cancer gene analysis with molecular pathology testing. She has previously received genetic counseling. Blood will be tested for full sequence analysis and common duplication or deletion variants (mutations) in BRCA1, BRCA2 (breast cancer 1 and 2). What CPT® code(s) is (are) reported for this molecular pathology procedure?
A. 81200
B. 81163, 81164
C. 81206
D. 81162

Answer 32

D. 81162

Rationale: In the CPT® Index, look for Breast/Cancer Gene Analysis/BRCA1 (BRCA1, DNA repair associate)/Duplication/Deletion or Full Sequence. The correct code is 81162 because the code description includes performing the full sequence analysis and duplication/deletion analysis for BRCA1 and BRCA2. This is a blood test performed to look for any gene mutations affecting the BRCA1 and BRCA2 genes. These human genes are known as tumor suppressors, mutation of these genes has been linked to hereditary breast and/or ovarian cancer. A woman’s risk of developing breast or ovarian cancer is increased if she inherits this harmful mutation. Men with this mutation also have an increased risk of breast cancer. Be sure to read the parenthetical instructions.

Question 33

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.
A. 80050
B. 80050-26
C. 80053, 84443
D. 80048

Answer 33

A. 80050

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.

Question 34

Referring to the CPT® codebook in the Evocative/Suppression subsection, if a patient has congenital adrenal hypoplasia (CAH) and testing is performed to identify if the insufficiency is due to 21 hydroxylase deficiency (insufficient stimulating hormones or inability to react to those hormones), what substances are tested for and how many times must the tests be performed?
A. Adrenocorticotropic hormone (ACTH) x 6
B. Cortisol x 2, 17 Hydroxyprogesterone x 2
C. Estradiol x 2
D. Aldosterone x 2, Renin x 2

Answer 34

B. Cortisol x 2, 17 Hydroxyprogesterone x 2

Rationale: In the CPT® Index, look for Adrenocorticotropic Hormone (ACTH)/Stimulation Panel or look for Evocative/Suppression Test/Stimulation Panel/ACTH referring you to 80400. Section guidelines state “In the code descriptors where reference is made to a particular analyte the “X 2” refers to the number of times the test for that particular analyte is performed.” Code 80402 for 21 hydroxylase deficiency states in the code descriptor: Cortisol (82533 x 2) and 17 Hydroxyprogesterone (83498 x 2).

Question 35

A major university medical center has an International Clinic specializing in treating individuals who move to the USA bringing with them diseases and conditions native to their home countries. A Brazilian woman presents to this clinic with complaints of hematuria and fatigue. Urine analysis with microscopy identifies eggs in the urine and further testing from a stool sample identifies Schistosomiasis through direct smear to concentrate and evaluate ova. What CPT® and ICD-10-CM codes are reported?
A. 87207, 81007, B65.0
B. 87177, 81000, B65.0
C. 87045, 81007, R31.9, R53.83
D. 87209, 81000, R31.9, R53.83

Answer 35

B. 87177, 81000, B65.0

Rationale: Look in the CPT® Index for Ova/Smear or look for Smear and Stain/Ova and Parasites Smear. Code 87177 is correct to report for direct smear. The correct code the urinalysis with microscopy is 81000. Look in the ICD-10-CM Alphabetic Index, look for Schistosomiasis/bladder referring you to B65.0. Verify the code in the Tabular List.

Question 36

The code for sweat collection by iontophoresis can be found in what section of the Pathology Chapter of CPT®?
A. Hematology
B. Cytopathology
C. Chemistry
D. Other Procedures

Answer 36

D. Other Procedures

Rationale: In the CPT® Index, look for Iontophoresis/Sweat Collection referring you to 89230. Code 89230 is under the heading, Other Procedures. The Other Procedures section includes codes for a number of miscellaneous procedures. Many of them are for analysis of substances found in other body substances and tissues. There are also a number of tests for specific conditions and diseases.

Question 37

A couple with the inability to conceive has fertility testing. The semen specimen is tested for volume, count, motility and a differential is calculated. The findings indicate infertility due to oligospermia. What CPT® and ICD-10-CM codes are reported?
A. 89310, 89320, Z31.41
B. 89320, N46.11
C. 89257, Z31.41
D. 89264, N46.11

Answer 37

B. 89320, N46.11

Rationale: Choose the CPT® code that completely identifies the service. Look in the CPT® Index for Semen Analysis. Code 89320 reports all of the tests performed. Only use multiple codes if there is no code describing everything performed.

In this case, a very specific diagnosis is known. For the ICD-10-CM diagnosis code, look in the ICD-10-CM Alphabetic Index for Infertility/male/oligospermia referring you to N46.11. Verification in the Tabular List confirms this code is reported for Oligospermia NOS.

Question 38

A patient with AIDS presents for follow up care. An NK (natural killer cell) total count is ordered. What CPT® code(s) is/are reported?
A. 86703
B. 86361, 86359
C. 86357
D. 86359

Answer 38

C. 86357

Rationale: Look in the CPT® Index for Natural Killer (NK) Cells/Count. Although there are a number of cells that attack viruses and other infectious organisms, NK cells are specifically identified by code 86357.

Question 39

Flow cytometry is performed for DNA analysis. What CPT® code is reported?
A. 88182
B. 88187
C. 88189
D. 88184

Answer 39

A. 88182

Rationale: Flow cytometry is a cytopathologic study. Look in the CPT® Index for Flow Cytometry/DNA Analysis, which directs you to code range 88182-88189. Code 88182 specifies flow cytometry for DNA analysis.

Question 40

In a legal hearing to determine child support there is a dispute about the child’s paternity. The court orders a paternity test, and a nasal smear is taken from the plaintiff and the child. The plaintiff is confirmed as the father of the child. Choose the CPT®, ICD-10-CM codes and modifier for the paternity testing of the plaintiff.
A. 86900, Z02.81
B. 86910 x 2, Z31.448
C. 89190-32, Z31.448
D. 86910-32, Z02.81

Answer 40

D. 86910-32, Z02.81

Rationale: Always choose codes identifying the service and reason for the service as specifically as possible. Look in the CPT® Index for Paternity Testing. Code 86910 represents testing for one person. Parenthetic comments in CPT® can sometimes assist in finding a challenging code. Modifier 32 is appropriate when services are mandated by courts or insurers.
In the ICD-10-CM Alphabetic Index, look for Encounter (with health service) (for)/administrative purpose only/examination for/paternity testing directing you to Z02.81.