Question 1

A pediatric patient with hyperpyrexia, headache and nausea presented to the office for a sick visit. Upon examination, the pediatrician determined that the patient needed a Complete Blood Count (CBC) to check for the presence and the amount of bacteria in the blood. The first CBC came back with a highly elevated number of white blood cells indicating infection. The pediatrician then ordered a Dexamethasone antibiotic injection in the office and waited three hours and then repeated CBC to recheck the patient's white blood cell count. The repeat CBC showed a decrease in the number of white blood cells indicating that the antibiotic injection was effective. The pediatrician then released the patient. What is the correct code for the CBC only?

Accepted Answer

The correct code for the CBC only is with 85025 (Blood Count; Complete, Automated, and Automated Differential WBC Count). This code needs to be indicated twice, as the test was performed twice and the modifier -91 needs to be appended to the second code to indicate that it was a repeat laboratory test. This code and modifier indicate that the same test was repeated in the office, as medically necessary and is not a mistake. Both tests are reimbursable.

Question 2

The patient presented to the physician's office for a comprehensive metabolic panel, but the physician was unable to obtain a sample of the patient's total calcium. What is the correct code for this laboratory service?

Accepted Answer

The correct codes for this laboratory service are: 82040, 82247, 82374, 82435, 82565, 82947, 84075, 84132, 84155, 84295, 84460, 84450 and 84520. These are all of the chemistry tests included as part of a comprehensive metabolic panel, minus the total calcium test. If the physician was able to get a sample of the calcium, the service would be reportable with the full panel code 80053, but because the calcium was not taken, each test must be reported individually.

Question 3

A patient was brought to the Emergency Department following a car accident. Suspecting that the patient had been drinking and driving, the physician ordered a _______________ alcohol pathology test. After determining that the patient did indeed have alcohol in their system, the physician then ordered a _______________ pathology test to check the amount of alcohol in the bloodstream.

Accepted Answer

Suspecting that the patient had been drinking and driving, the physician ordered a qualitative alcohol pathology test. After determining that the patient did indeed have alcohol in their system, the physician then ordered a quantitative pathology test to check the amount of alcohol in the bloodstream. A qualitative pathology test checks only for the presence of a specific substance, in this case alcohol. After the qualitative results come in positive, a quantitative test checks for the actual amount of the substance in the blood stream (the actual quantity of the substance).

Question 4

An adolescent comes to the lab for drug testing. The lab tests the patient for three drug classes: alcohols, cocaine and metabolites and tetrahydrocannabinols. The laboratory uses the chromatographic method to test all three drug classes with one screening. The patient comes up positive for tetrahydrocannabinols, but negative for the remaining drug classes. A confirmation test is performed to confirm the positive test results. What is the correct code for this laboratory service?

Accepted Answer

The correct code for this laboratory service is 80100, for the testing of all three drug classes using one chromatographic test. Code 80102 also needs to be included to indicate that a confirmation test was performed on one of the drug classes, which tested positive. Code 80101 is only appropriate if the laboratory equipment indicated that only one drug class was tested at a time. If this is the case, code 80101 should be reported with three units.

Question 5

A 28-year-old woman presented to the OB/GYN stating that she tested positive on a home pregnancy test. The OB decides to perform a urine pregnancy test in the office for confirmation. What is the OB code for the pregnancy test only?

Accepted Answer

The correct OB only code is 81025 (Urine Pregnancy Test by Visual Comparison Methods). Codes 81002 and 81003 should not be included on the claim because they are used for in-office urinalyses with results that indicate something other than pregnancy such as: protein or white blood cells in the urine. Code 81025 is the appropriate code for the urine pregnancy test because it includes the urine sample and indicates a pregnancy.

Question 6

What is the name of the regulations, which were passed in 1988, to ensure quality standards for all laboratory testing?

Accepted Answer

The name of the regulations, which were passed in 1988, to ensure quality standards for all laboratory testing, are the Clinical Laboratory Improvement Amendments (CLIA). These tests fall into three categories: waived tests, tests of moderate complexity, and tests of high complexity. Any lab or clinic providing any of the three types of tests must have a CLIA number. In addition, the bills for the laboratory tests must include the CLIA number of the provider completing the test.

Question 7

During the surgical session, the pathologist received and performed analyses on three separate biopsies from the vaginal wall and one from the cervix. How should the surgical pathologist code for this service?

Accepted Answer

The surgical pathologist should code for this service with 88305 (with 4 units). Code 88305refers to the four separate biopsies performed during the surgical session. The three vaginal biopsies should be coded separately because they account for the three separate samples. Furthermore, the vaginal biopsies fall within the Level IV surgical pathology section. The cervical biopsy should also be coded with a Level IV surgical pathology code because it also falls within that category. If the sample was a conization of the cervix, it should have fallen within the Level V surgical pathology category and coded with 88307.

Question 8

The surgical pathologist obtained three skin tags samples from in the patient's right axilla, as well as four samples of breast tissue from the surgical session. The surgical procedure was a radical bilateral mastectomy, including excision of regional lymph nodes and surrounding tissue. How should the surgical pathologist code for this service?

Accepted Answer

The surgical pathologist should code for this service using codes 88304 with 3 units, to indicate the sampling of three separate skin tags. Code 88309 with 4 units should be used to indicate the four separate samples of breast tissue. Level VI codes (88309) are more appropriate than Level V codes (88307) because the procedure was a mastectomy with removal of regional lymph nodes. If the procedure had been a partial or simple mastectomy, then code 88307 (Level V) would have been the correct surgical pathology code.

Question 9

A comprehensive metabolic panel and a general health panel is ordered and performed on a patient. What is the correct CPT coding for these laboratory orders?

Accepted Answer

80050 is the correct code for a general health panel and, because the general health panel includes the comprehensive metabolic panel, this panel is not coded in addition to the 80050.
Code 80053 is incorrect because this code is for the comprehensive metabolic panel, but because another panel that is more extensive that includes the comprehensive metabolic panel was also ordered, this code overlaps with the general health panel code 80050. Code 80051 is incorrect because this code is for an electrolyte panel, which is part of the comprehensive metabolic panel and part of the general health panel. Code 80048 is also incorrect because this is a basic metabolic panel, which is included within the comprehensive metabolic panel.

Question 10

A 26 year old must have a drug screen performed in order to obtain a job at a local nursing home. The nursing home orders a 7-panel drug screen for amphetamines, benzodiazepines, cocaine, heroin, methadone, opiates, and oxycodone. If any of these come up positive by direct optical observation, then definitive drug testing is ordered as reflex testing. This patient did not have any positives on optical observation so no additional testing was performed. What is the correct CPT code for this drug screen?

Accepted Answer

80300 is the correct code for direct optical observation drug testing of any number of drug classes from Drug Class A. Because no additional testing was performed, there is no need for additional codes.
Code 80301 is incorrect because this is for a single drug class using instrumented tests systems. Code 80302 is incorrect because this code is for Drug Class List B and 80303 is incorrect because this code is used for any number of drug class screens using chromatography procedures and not direct optical observation.

Question 11

A patient who has been on Digoxin needs to have labs drawn to verify his response to the medication. A total Digoxin level is ordered. What is the correct CPT code for this test?

Accepted Answer

80162 is the correct code for a total Digoxin level.
Code 80163 is incorrect because this code is for a free Digoxin level. Code 80159 is incorrect because this code is for the therapeutic drug assay for clozapine and code 80178 is the code for a lithium therapeutic drug assay.

Question 12

A patient is on two medications needing monitoring. She needs to have a free and total phenytoin drug assay performed. She also needs to have a Topiramate drug assay performed. What are the correct CPT codes for these tests?

Accepted Answer

80185 and 80186 are the correct codes for total and free Phenytoin, and code 80201 is the correct code for Topiramate therapeutic drug assay tests.
Code 80184 is incorrect because this code is used for the drug Phenobarbital. Code 80183 is incorrect because this code is for the drug Oxcarbazepine and code 80200 is incorrect because this code is for the drug Tobramycin.

Question 13

A patient is on Quinidine and needs to have therapeutic drug assay testing completed to verify that he is on the optimal dosage. What is the correct CPT code for this test?

Accepted Answer

80194 is the correct code for Quinidine therapeutic drug assay testing.
Code 80190 is incorrect because this code is for Procainamide. Code 80195 is incorrect because this code is for Sirolimus and 80197 is incorrect because this code is for the drug Tacrolimus.

Question 14

A patient needs to have an ACTH stimulation panel performed to assess adrenal insufficiency. What is the code for reporting the laboratory component of the testing protocol that should be used for this test?

Accepted Answer

80400, 82533 x 2 is the correct code for the ACTH stimulation panel test because the particular analyte (Cortisol) is used with the number of times it is performed during the test.
Code 84143 is incorrect because this code is for the particular analyte 17 hydroxypregnenolone.

Question 15

A patient needs to have a TRH (thyrotropin releasing hormone) stimulation panel performed over one-hour duration. What is the correct reporting code for the laboratory component of this testing panel?

Accepted Answer

80438, 84443 x 3 are the correct codes for the laboratory component of the TRH stimulation panel. 80438 is the correct code for the one-hour version of this test and 84443 x 3 is the correct code for 3 TSHs to be performed in this panel.
Code 80439 is incorrect because this code is for the 2-hour version of this test.

Question 16

A patient needs to have an insulin tolerance panel done to assess ACTH insufficiency. What is the appropriate reporting code(s) for the laboratory component of this testing?

Accepted Answer

80434, 82533 x 5, 82947 x 5 is the correct code for this test. Code 80434 is the correct code for the insulin tolerance panel for ACTH insufficiency. Code 82533 is the correct code for Cortisol, which is tested five times, and 82947 is the correct code for Glucose, which is tested five times in this panel.
Code 80432 is incorrect because this code is for the insulin induced C-peptide suppression panel.

Question 17

A physician requests a clinical pathology consultation on one of his cancer patients on whom he would like to have an in-depth analysis done. He would like the pathology findings to be further defined in conjunction with that patient's medical history and records. The pathologist complies with an in-depth review and written report of his medical interpretive judgment. What is the correct code for this type of consultation?

Accepted Answer

80502 is the correct code for a comprehensive consultation with pathology, including review of patient's history and medical records.
Code 80439 is incorrect because this code is for a 2-hour thyrotropin releasing hormone (TRH) stimulation panel. Code 80500 is incorrect because this code is for a limited clinical pathology consultation and 81000 is incorrect because this code is for a urinalysis.

Question 18

A pathologist has been requested to consult with general surgery about lymph node findings. He doesn't know the patient's medical history or have access to the medical records so this consultation is considered to be limited. What is the correct CPT code for this consultation?

Accepted Answer

80500 is the correct code for a limited clinical pathology consultation.
Code 80502 is incorrect because this code is for a comprehensive consultation. Codes 81000 and 81005 are incorrect because both of the codes refer to urinalysis testing.

Question 19

A primary care physician contacts the pathologist at the local hospital because of an anomaly on his patient's pathology report. He asks the pathologist to write a medical interpretive judgment, without ever seeing the patient or knowing more about the patient's history. The pathologist is happy to do this, reexamines the pathology sample and writes a report that he shares with the primary care physician for further clarification. What is the correct code for this type of a consultation?

Accepted Answer

80500 is the correct code for limited clinical pathology consultation.
Codes 80400 and 80402 are both incorrect because these codes reference evocative/suppression testing codes. Code 80502 is incorrect because this code is for a comprehensive clinical pathology consultation including review of the patient's history and medical records.

Question 20

A patient is in his primary care doctor's office and needs to have a urinalysis done. They do a dip stick in the office that is not automated and doesn't require microscopy. What is the CPT code for this procedure?

Accepted Answer

81002 is the correct code for a non-automated, without microscopy urinalysis.
Code 81000 is incorrect because this code is for a non-automated urinalysis with microscopy. 81001 is incorrect because this code is for an automated urinalysis with microscopy. Code 81003 is incorrect because this code is for automated urinalysis without microscopy.

Quiz 9: Laboratory and Pathology