Wiki G0452/80500

[anitajlash]

G0452 is the code CMS requires us to use to Molecular Pathology Interpretation. Prior to 1/1/2022, we used 80500 for non-Medicare patients (CAP). This code is no longer valid.....what are other options to use for the professional interp of a Molecular test?

Thanks!

Anita Lashmit, CPC, CHCO
Manager, Coding & Billing
Anatomical & Clinical Pathology

 

[LaurieEaston]

Hi Anita,
Are you coding for consultation?

80500 represented "Clinical pathology consultation; limited, without review of patient's history and medical records". To report a clinical pathology consultation, limited or comprehensive, see 80503,80504, 80505, or 80506.

From Medicare NCCI 2022 Coding Policy Manual page 21 ( https://www.cms.gov/files/document/chapter10cptcodes80000-89999final11.pdf ):
"CPT codes 80503-80506 describe clinical pathology consultation services. CMS has specific rules for reporting consultation services. Reporting of these services may be based on either the total time for pathology clinical consultation services performed on the date of consultation or level of medical decision making. There must be a written order for the clinical pathology consultation from the treating physician. A standing order is not an acceptable substitute for an individual written order by the treating physician. (Federal Register, Volume 62, Number 211, October 31, 1997, Page 59077). The consultation must be related to an abnormal test result that requires medical judgment by a physician (M.D. or D.O.). Since the clinical pathology consultation requires that medical judgment be exercised, the nature of the consultation must include information that could not be provided by a laboratory scientist, technologist, or technician. A written report documenting the consultation must appear in the medical record. A clinical pathology consultation does not require face-to-face patient contact. If face-to-face contact is medically reasonable and necessary, an E&M CPT code may be reported in lieu of a clinical pathology consultation code. Since E&M services include interpretation of laboratory test results, a clinical pathology consultation code shall not be reported with an E&M code on the same date of service. CPT codes 80503-80506 shall not be reported for consultation related to a pathology or laboratory service that includes a physician interpretation. (CPT codes 80500 and 80502 were deleted January 1, 2022.)"

I hope this is helpful,
Laurie Easton, CPC, CPB