Pathology/Lab Coding Alert

All consultations are not created equal. Even abiding by the three R's (request, report, and render opinion) won't lead you to the correct codes for a pathologist's consultation. You also have to know the answer to the two W's what and when. "Three distinct code families describe pathology consultations," says Kenneth Wolfgang, MT (ASCP), CPC, CPC-H, director of coding and analysis for National Health Systems Inc., a coding consultation company in Camp Hill, Pa. You can get to the right page in the CPT book if you answer these two questions: 1. What does the physician request a consult for a clinical laboratory test or anatomic pathology assessment? 2. When does the pathologist consult with the physician following initial abnormal findings or as the primary analysis during surgery? Once you're on the right page, learning the nuances of each code family is easy, then you're on your way to correct pathology consultation coding. Know Clinical Pathology Consultation Rules One set of codes for pathology consultations is CPT 80500 (Clinical pathology consultation; limited, without review of patient's history and medical records) and 80502 (... comprehensive, for a complex diagnostic problem, with review of patient's history and medical records). The breadth of the assessment distinguishes the two codes, with 80502 reserved for cases requiring the pathologist's full review of patient history and records. You know that these are the proper consultation codes when you have the following answers to the two W's: 1. What the physician requests a consultation for a clinical lab test result. 2. When the consultation follows an abnormal test finding. Only report the clinical pathology consultation when you meet the following criteria, according to Section 15020-D of the Medicare Carriers Manual (MCM): The patient's attending physician orders the consultation, not just the underlying lab test. Medicare specifies that standing orders do not satisfy this request requirement. The consultant must issue a written report. The consultation requires the exercise of medical judgment by the consulting physician. The lab test result behind the consultation must lie outside the clinically significant normal or expected range in view of the patient's condition. "Don't confuse this service with the physician interpretation of a clinical lab test," Wolfgang says. Medicare has designated 18 lab tests as having a professional interpretation component that it will reimburse under the Physician Fee Schedule. Included are hemoglobin electrophoresis (83020), molecular diagnostics (83912), protein electrophoresis and Western Blot (84165, 84181, 84182), immunoelectrophoresis (86320-86327), and fluorescent noninfectious agent antibody tests (86255, 86256). The MCM section 15020-E contains the complete list. To report the interpretation, the pathologist must meet the first three criteria listed above for a consultation, except that standing orders will suffice for the request. "Rather than using 80500 [...]