Pathology/Lab Coding Alert

Heed consult rules and dodge 80500 payment woes

Keep your eye on the difference between lab oversight and lab consultation, and you can reap a $20 reward. That's roughly what Medicare pays for a pathologist's professional consultation on an abnormal lab test. Don't Let -Oversight- Rule Mislead You You can't bill a consultation fee for a pathologist's direction, supervision and other oversight services in the laboratory. But if your pathologist consults on a specific lab test, you may be able to claim your legitimate pay.

Use 80500 (Clinical pathology consultation; limited, without review of patient's history and medical records) or 80502 (- comprehensive, for a complex diagnostic problem, with review of patient's history and medical records) to report the consultation service--but only if the circumstances fulfill the requirements discussed in -Avoid Missteps With Clinical Lab Professional Services--Here's How- included within this issue. Legitimately Clear CCI Payment Hurdle Medicare's national Correct Coding Initiative (CCI) throws coders a curve ball by bundling 80500 and 80502 with hundreds of lab tests. That doesn't mean you can never report one of the two codes with a lab test code. Situations arise that involve ambiguous or conflicting test results, and the attending physician may call on the pathologist to help sort things out. That means you can most likely bill a viable clinical consult charge in this case, despite the CCI edit.

CCI bundles 80500 and 80502 with the following codes:

- all 20 lab tests approved by Medicare for pathologist interpretation of clinical lab tests
- some lab panels, such as 80061 (Lipid panel)
- evocative/suppression testing (80400-80440)
- select chemistry codes, such as blood gases (82800-82820), lipids and triglycerides (83700-83721, 84478), and molecular diagnostics (83890-83914)
- many hematology and coagulation codes (85170-85732)
- numerous immunology codes, including flow cytometry total cell counts for immunodeficiency testing (86355-86367)
- certain microbiology codes, including infectious agent antigen detection by immunofluorescent technique (87260-87300), nucleic-acid probes (87470-87801) and immunoassay with direct optical observation (87802-87899)
- many cytogenetic studies, including in situ hybridization (ISH) (88271-88275). -Notwithstanding the CCI edits, you can bill a professional fee for a consultation related to a clinical lab test when the pathologist provides and documents the service according to the criteria outlined in the Medicare Claims Processing Manual section 60 D,- says Dennis Padget, MBA, CPA, FHFMA, president of DLPadget Enterprises Inc., a pathology business practices company in Simpsonville, Ky., publisher of Pathology Service Coding Handbook.

But these edit pairs are a constant reminder that Medicare expects clinical consult charges by pathologists to be very few in number, Padget says.

Don't miss: Labs must be aware of these CCI edits and code accordingly. The edits impact independent laboratories more than hospital labs because hospitals deal with two [...]