CPC- Pathology and Laboratory Questions (80000)

A 30-year-old female is coming in for a routine gynecological exam. A pap smear is taken from the cervix and the screening is done by an automated system under provider supervision. What lab code should the provider report? A. 88164 B. 88174 C. 88147 D. 88148

C

A 68-year-old cardiac patient must take digoxin to treat his atrial fibrillation. This condition has been controlled for several years but the patient now presents to his physician with new complaints of irregular heartbeats. The physician orders a total digoxin study to determine the total level of digoxin in order to measure the drug's efficacy in treating his Afib. What CPT code is reported? A. 80299 B. 80163 C. 80162 D. 82542

C

A provider performs surgical removal of two skin lesions: one becoming a pigmented nodule measuring 2cm x 2.5cm on the left upper back; the second lesion, an inclusion cyst measuring 2.5cm x 3cm in the middle back. Both specimens are placed in individual containers and sent to surgical pathology for gross and microscopic examination. What is the correct coding for this service? A. 88304 x2 B. 88305 x 2 C. 88304, 88305 D. 88304 x2, 88329

C

An established patient comes in complaining of nausea and vomiting and states she has not had a menstrual period in over a month. A complete CBC and automated differential WBC is ordered. The provider also orders: Hepatitis B antigen, Rubella, RPR, Antibody screen, blood typing for Rh and ABO, and a urine pregnancy test. What is the correct CPT coding for the laboratory testing? A. 80055 B. 85004, 87340, 86762, 86850, 86900, 86901, 81025 C. 80055, 81025 D. 85025, 87340, 86762, 86592, 86850, 86900, 86901

C

A type 2 diabetic patient presents feeling weak. The physician performs a stat glucose test in which a finger stick is done placing the drop of blood on a reagent strip. The test indicates the patient is hypoglycemic. The physician gives the patient some glucose supplements and performs another stat glucose test using the same lab test as before 30 min later. The second test shows the glucose levels returned to normal. How are the lab tests reported? A. 82948, 82948-76 B. 82948, 82948-90 C. 82948, 82948-91 D. 82948, 82948-92

C Appendix A will help to select appropriate modifier. A is for repeat procedure, not repeated lab

An established patient comes in complaining of nausea and vomiting and states she has not gotten her menstrual period. A complete CBC and automated differential WBC was ordered. Also Hepatitis B antigen, Rubella, RPR, Antibody Screen, Blood Typing for Rh and ABO along with a urine pregnancy test. The correct CPT® code(s) for the laboratory service(s) is (are): A. 80055 B. 80081 C. 80055, 81025 D. 85025, 87340, 86762, 86592, 86850, 86900, 86901

C In the CPT® Index, look for Blood Tests/Panels/Obstetric Panel. You are referred to 80055, 80081. Review the codes to verify accuracy. Panel code 80081 is not the correct OB panel to report the tests that are indicated in the question because there was not an HIV test performed. The majority of the lab tests are in panel code 80055. According to CPT® guidelines, "In order to report a code for a panel, all of the tests listed in the panel definition must be performed. If tests are performed in addition to those listed in the panel definition, they should be reported in addition to the panel code." For this encounter an additional test, urine pregnancy test, was ordered but is not part of the obstetric panel code 80055. It can be reported separately. In the CPT® Index look for Pregnancy Test/Urinalysis. You are referred to 81025. Review the code to verify accuracy.

A 28-year-old who is unconscious is brought to the ER for possible ingestion of opiates or methamphetamine. A drug screening is ordered, and the lab performs a single drug class using discrete multichannel chemistry analyzers utilizing immunoassay. Confirmation was then performed for opiates. What codes should be used for reporting the testing and confirmation? A. 80305, 80361 B. 80307, 80361 C. 80306, 80362 D. 80307 x2, 80362

Fine the method that is used for the drug screen or test. In the question a multichannel chemistry analyzer utilizing immunoassay. A and C is eliminated. 80307 is only reported once Confirmation test is performed for opiates, reporting code 80361

A pathologist performs a comprehensive consultation and report after reviewing a patient's records and specimens from another facility. The correct CPT® code to report this service is: A. 88325 B. 99244 C. 88323 D. 88329

In the CPT® Index, look for Surgical Pathology/Consultation referring you to 88321-88325. 88325 is the correct code. The correct code is 88325 to indicate that the comprehensive consultation is being done by reviewing the patient's records and on specimens from a different facility. Code 99244 is reported when the consultation is involving the examination and evaluation of the patient. Code 88323 is the consultation and report on referred material requiring preparing of slides. Code 88329 is when a consultation is performed during a surgery.

Sperm is being prepared through a washing method to get it ready for the insemination of five oocytes for fertilization by directly injecting the sperm into each oocyte. Choose the CPT® codes to report this service. A. 89257, 89280 B. 89260, 89280 C. 89261, 89280 D. 89260, 89268

Sperm isolation is performed. Sperm washing refers to separating the sperm from semen and getting rid of dead or slow-moving sperm as well as additional chemicals that may impair fertilization (89260). The selection of the second listed code is for the number of oocytes fertilized. The correct code is 89280 to indicate less than 10 were fertilized.

An embryologist is performing a conventional in vitro insemination of oocytes and assisting in the fertilization of four oocytes under micro technique for an infertile couple using ART. How are the services of the embryologist coded? A. 89268, 89280 B. 58321, 89251 C. 58322, 89281 D. 89260, 89280

A

An 18-year-old female with a history of depression comes into the ER in a coma. The ER physician orders a drug screen on antidepressants, phenothiazines, and benzodiazepines. The lab performs a screening for single drug class using an immunoassay in a random access chemistry analyzer. Presence of antidepressants is found and a drug confirmation is performed to identify the particular antidepressant. What correct CPT® codes are reported? A. 80307, 80338 B. 80305, 80338 C. 80306 x 3, 80332 D. 80307 x 3, 80333

A To report codes for drug testing depends on the method of the testing. The scenario indicates a chemistry analyzer utilizing immunoassay method was used, guiding you to code 80307. Subsection guidelines for Presumptive Drug Class Screening indicates: Use 80307 once to report single or multiple procedures, classes, or results on any date of service. A drug confirmation was performed on antidepressants, reporting code 80338 because the type of antidepressant is not documented.

A patient has a cytopathology study performed by a fine needle aspiration. The results are quite unusual and the slides as well as a copy of pertinent information from the patient's record are sent to another cytopathologist for consultation. The consulting pathologist reviews the slides, patients' history, and reviews the patients chart material. A report is sent back to the original pathologist with the findings. What CPT code is reported? A. 88173 B. 80502 C. 80500 D. 99245

B

A 32-year-old patient with a history of illegal opiate drug use arrives at the ER in a coma. The treating provider orders a multiple class drug screen using TLC method to detect the presence of drugs. The report comes back positive. The provider orders a confirmatory test using high performance liquid chromatography. What is the correct CPT code/s for the laboratory testing? A. 80305, 80307 B. 80305 C. 80305, 80306 D. 80307, 80361

D

A provider orders a fibrin degradation ultrasensitive test to evaluate for possible DVT. What is the laboratory code to report? A. 85362 B. 85378 C. 85379 D. 85380

D

An autopsy is performed to gain evidence for the police investigation and any subsequent trail on a 21-year-old female who dies of a gunshot wound. What CPT code is reported? A. 88005 B. 88045 C. 88025 D. 88040

D

Patient is coming in for a pathological examination for ischemia in the left leg. The first specimen is 1.5 cm of a single portion of arterial plaque taken from the left common femoral artery. The second specimen is 8.5 x 2.7 cm across x 1.5 cm in thickness of a cutaneous ulceration with fibropurulent material on the left leg. What surgical pathology codes should be reported for the pathologist? A. 88304-26, 88302-26 B. 88305-26, 88304-26 C. 88307-26, 88305-26 D. 88309-26, 88307-26

B Code 88305 - Skin, other than cyst/tag/debridement/plastic repair is for the cutaneous ulceration on the left leg. Code 88304 - Artery, atheromatous plaque is for the arterial plaque taken from the femoral artery. Modifier 26 is appended to show the pathologist's service.

Cells were taken from amniotic fluid for analyzation of the chromosomes for possible Down's syndrome. The geneticist performs the analysis with two G-banded karyotypes analyzing 30 cells. Select the lab code(s) for reporting this service. A. 88248 B. 88267, 88280, 88285 C. 88273, 88280, 88291 D. 88262, 88285

B The chromosome analysis was taken from amniotic fluid eliminating multiple choices A, C and D. The selection of the codes are based on the type of sample used, the number of karotypes performed, and the number of cells studied. There were two karyotypes performed with analyzing 30 cells. Code 88267 identifies the sample as amniotic fluid with only one karyotype and 15 cells studied. Code 88280 is reported for the additional karyotype. Code 88285 is reported for the remaining 15 cells.

During a craniectomy the surgeon asked for a consult and sent a frozen section of a large piece of tumor and sent it to pathology. The pathologist received a rubbery pinkish tan tissue measuring in aggregate 3 x 0.8 x 0.8 cm. The entire specimen is submitted in one block and also a gross and microscopic examination was performed on the tissue. The frozen section and the pathology report are sent back to the surgeon indicating that the tumor was a medulloblastoma. What CPT® code(s) will the pathologist report? A. 80503 B. 88331-26, 88307-26 C. 80505 D. 88331-26, 88332-26, 88304-26

B The pathology consultation of the tumor is performed during a surgery guiding you to code 88331. Code 88331 is only reported once because one block is submitted. Codes 80503 and 80505 are reported according to CPT® guidelines when the pathologist gives a response to a request from an attending physician in relation to a test result(s) requiring additional medical interpretive judgment. A gross and microscopic examination was also performed reporting code 88307.

A patient with severe asthma exacerbation has been admitted. The admitting physician orders a blood gas for oxygen saturation only. The admitting physician performs the arterial puncture drawing blood for a blood gas reading on oxygen saturation only. The physician draws it again in an hour to measure how much oxygen the blood is carrying. Select the codes for the blood gas testing. A. 82805, 82805-51 B. 82810, 82810-91 C. 82803, 82803-51 D. 82805, 82805-90

B The physician requests a blood gas for oxygen saturation (0₂) only, guiding you to code 82810. Modifier 51 is appended to surgical procedure codes meaning because this code is a lab code, modifier 51 is inappropriate, eliminating multiple choice answers A and C. There is no mention of an outside lab, eliminating multiple choice D. The physician would also report 36600 for the arterial puncture.

A surgical removal of two skin lesions, one being a pigmented nodule measuring 2 cm x 2.5 cm on the left upper back and the second lesion an inclusion cyst measuring 2.5 cm x 3 cm in the middle of the back. Both specimens were placed in individual containers to surgical pathology for gross and microscopic examination. Select the appropriate coding. A. 88304 x 2 B. 88305 x 2 C. 88304, 88305 D. 88304 x 2, 88329

C In the CPT® Index, look for Pathology and Laboratory/Surgical Pathology/Gross and Micro Exam. You are referred to a range of codes that are for Level II - Level VI. Review the codes to choose appropriate services. For this encounter two lesions were removed. The first one being a pigmented nodule that falls under the code 88305 (Skin-other than cyst/tag/debridement/plastic repair). The second excision was an inclusion cyst that falls under the code 88304 (Skin-cyst/tag/debridement).

A patient uses Topiramate to control his seizures. He comes in every two months to have a therapeutic drug testing performed to assess serum plasma levels of this medication. What lab code(s) is (are) reported for this testing? A. 80305 B. 80375 C. 80201 D. 80306, 80375

C The lab test being performed in this scenario is for therapeutic drug monitoring to assist the physician in drug regimen adjustment to reach an optimal drug concentration ensuring an adequate therapeutic response without drug-induced adverse effects, guiding you to codes 80150-80299. The patient is not having a drug screening test in which the physician is determining a specific drug present or not present in the patient (qualitative) eliminating multiple choice answers A and D. Therapeutic Drug Assay codes are performed to monitor clinical response to a known, prescribed medication.

Lab analyst performs the following lab test: electrolyte panel, comprehensive metabolic panel, and total serum, cholesterol test. How are these lab tests reported? A. 80053, 80061 B. 80051, 80053, 82465 C. 80053, 82465 D. 80051, 80053, 80061

C The lipid panel is snot reported because only one test was performed in that panel. So only report total serum cholesterol test 82465, eliminating A and D. When a group of tests overlaps 2 or more panel's report the panel that incorporates the greater number of tests. Electrolyte panel has 4 tests that overlap with the comprehensive metabolic panel

A 32 year-old patient with a history of illegal drug use arrives at the ER in a coma. The treating physician orders a presumptive multiple class drug using thin layer chromatography to screen and detect the presence of drugs. The report comes back positive for opiates. The physician orders a drug confirmatory test. The correct CPT® codes for the laboratory tests are: A. 80307, 80362 B. 80306, 80362 C. 80305, 80361 D. 80307, 80361

D In the CPT® Index, look for Drug Assay/Drug Procedure/Presumptive Drug Class. You are referred to code 80305-80307. Review the codes to choose appropriate service. 80307 is the correct code because the method used is chromatography. In the CPT® Index, look for Drug Assay/Definitive Drug Class/Opiates, 1 or more. You are referred to 80361. Review code to verify accuracy.

Per CPT® guidelines for Organ or Disease-Oriented Panels how is a basic (80047) and comprehensive metabolic (80053) panels reported? A. 80053, 80047 B. 80053 C. 80047, 82040, 82247, 82310, 84075, 84155, 84460, 84450 D. 80053, 82330

D Subsection guidelines in the CPT® codebook under Organ or Disease-Oriented Panels state: "Do not report two or more panel codes that include any of the same constituent tests performed from the same patient collection. If a group of tests overlaps two or more panels, report the panel that incorporates the greater number of tests to fulfill the code definition and report the remaining tests using individual test codes." The comprehensive metabolic panel has the greater number of tests than the basic metabolic panel, eliminating multiple choice answers A and C. Code 82330 (Calcium, ionized) is not listed under panel code 80053, and because that is the remaining test in the basic metabolic panel that is not included in the comprehensive metabolic panel it is also reported, eliminating multiple choice answer B.

Patient that is a borderline diabetic has been sent to the laboratory to have an oral glucose tolerance test. Patient drank the glucose and five blood specimens were taken every 30 to 60 minutes up to three hours to determine how quickly the glucose is cleared from the blood. What code(s) is (are) reported for this test? A. 82947 x 5 B. 82946 C. 80422 D. 82951, 82952 x 2

D The test being performed is a glucose tolerance test (GTT) guiding you to code 82951. Five blood specimens were taken in which the first three blood specimens are reported with code 82951. The last two blood specimens will be reported with code 82952 twice.