Take the Consultation Challenge Take the Consultation Challenge
Published on Sun Jun 01, 2003
It's good to know the rules, but the proof is always in the pudding. Because three distinct code families describe pathology consultations, your challenge is to face a reallife lab report and code it correctly. Test your understanding of pathology consultation codes (80500-80502, 88321-88323 and 88329-88332) by trying to code the following scenarios. Then see how you did by reading the expert's answers. Scenario 1: A physician orders a lupus inhibitor panel and then requests that the pathologist review the findings to evaluate the implication of an abnormal result on the Russell viper venom test. The pathologist submits a written report indicating the clinical significance of the test results. How would you code this? Coding for Scenario 1: In addition to the clinical lab test codes (for example, 85612, Russell viper venom time [includes venom]; undiluted; and CPT 85730 , Thromboplastin time, partial [PTT]; plasma or whole blood), you should report the consultation using CPT 80500 (Clinical pathology consultation; limited, without review of patient's history and medical records). "Because Medicare's National Correct Coding Initiative (NCCI) edits bundle 80500 as a component of 85612, you must append modifier -59 (Distinct procedural service) to the consultation code," says Elizabeth Sheppard, HT (ASCP), manager of anatomic pathology at Wake Forest University Baptist Medical Center in Winston Salem, N.C. Scenario 2: A pathologist from an outside lab requests a second opinion on a hysterectomy, sending your lab three hematoxylin and eosin (H&E) slides, one iron-stain slide, and one CD5 antibody histochemistry slide. The referring lab also sends a tissue block. The pathologist at your lab examines the five submitted slides and prepares two more H&E slides from the tissue block, as well as two slides with different immunocytochemistry stains. The pathologist issues a written report to the referring lab. How would you code this? Coding for Scenario 2: Report the consultation service as 88323 (Consultation and report on referred material requiring preparation of slides). "Although the referring lab sent some pre-prepared slides, it also sent a block that your lab used to prepare additional H&E slides," says Laurie Castillo, MA, CPC, CPC-H, CCS-P, past member of the National Advisory Board of the American Academy of Professional Coders and vice president of ambulatory services, Health Revenue Assurance Associates in Chapel Hill, N.C. Consequently, you shouldn't report the service as 88321 (Consultation and report on referred slides prepared elsewhere), Castillo says. Nor should you report 88321 and 88323 together. "You should not report both consultation codes, because your pathologist provides only one consultation," Sheppard says. The unit of service for the consultation is the surgical case, which includes all submitted slides and tissue relating to the hysterectomy. Also, NCCI edits bundle 88321 as a component of [...]
