Friday, March 25, 2011

cpt code 80500, 80502, 88300,88309, 88321 , 88342 - Laboratory and pathology

Laboratory and pathology codes during colonoscopy episode


Description CPT/HCPCs
Consultations (Clinical pathology)
Clinical Pathology Consultation, Limited, Without Review Of Patient's History And Medical Records 80500
Clinical Pathology Consultation, Comprehensive, For A Complex Diagnostic Problem, With Review Of Records 80502


Surgical Pathology
Level I - Surgical Pathology, Gross Examination Only 88300
Level III - Surgical Pathology, Gross And Microscopic (Abscess, Colon, Colsotomy, Hematoma, Soft Tissue Debridement) 88304
Level IV - Surgical Pathology, Gross And Microscopic (Colon Biopsy, Lymph Node Biopsy, Colorectal Polyp) 88305
Level V - Surgical Pathology, Gross And Microscopic (Colon, Segmental Resection, Other Than For Tumor, Liver Biopsy Or Partial Resection) 88307
Level VI - Surgical Pathology, Gross And Micoscopic (Colon, Resection For Tumor, Total Colon Resection) 88309
Special Stains, Histochemical With Frozen Section 88314
Consultation And Report On Referred Slides Prepared Elsewhere 88321
Consultation And Report On Referred Material Requiring Preparation Of Slides 88323
Consultation, Comprehensive, With Review Of Records And Specimens 88325
Immunohistochemistry (including tissue immunoperoxidase), each antibody 88342



These codes identify colonoscopy-related services during the measurement period, regardless of corresponding ICD-9 codes.




Code 88321 Consultation and report on referred slides prepared elsewhere.

* Code 88321 includes review of special stain, IHC, immunofluorescence, and other special procedure slides and test data prepared and initially interpreted at the referring facility.  Special procedures can be separately charged if they are prepared or repeated by the lab at which the consultant practices.

* A slide made solely as the basis for a special stain, IHC, etc. ordered by the consultant doesn’t count as a routine preparation.{CAP Today, Oct. 2001}

* The number of slides received and examined with an outside consultation case nor their type is taken into account when deciding that 88321 is the proper code to report for a case.

* The number of individual specimens represented by the case will not change the code.

* Clinical history, pathologic diagnosis, and complexity will not justify a code higher than 88321.

Code 88323 Consultation and report on referred material requiring preparation of slides.

* If additional routine preparations are needed, for example the ones it came with are not sufficient and re-cuts or deeper sections are required or piece of the original specimen; in other words, the consultant needs his or her lab to prepare additional routine preparations (e.g., H&E slides), because those that came with the case aren’t sufficient for some reason. {AMA CPT-IS, KB #1429, Nov. 1, 2007}

* A separate charge for the added routine-stained slides cannot be billed.

* The added slide(s) must be used as an integral part of the evaluation.

* The added slide(s) can’t have been made principally as the foundation for a special stain, IHC, immunofluorescence, or some other special study that’s been ordered by the consultant. {CAP Today, Oct. 2001}

* The number of slides received and examined with an outside consultation case nor their type (e.g., H&E vs. special stain vs. IHC vs. EM micrographs) is taken into account when deciding that 88323 is the proper code to report for a case.

* The number of individual specimens represented by the case doesn’t influence the code. * Clinical history, pathologic diagnosis, and complexity in general don’t in and of themselves justify code 88323 or a code higher or lower than 88323.

Code 88325 Consultation, comprehensive, with review of records and specimens, with report on\ referred material.

* It’s used when patient records beyond the outside pathology report and associated slides/material are considered by the consultant to make the diagnosis.

* The College says 88325 is “used with review of the patient’s chart, laboratory results, oncologist’s consultations, etc.,” but it’s not appropriate for posting “when review of the record is limited to pathology reports.” {“Cracking the code…,”CAP Today, July 1999}

* Bundled within base code 88325 is review of special stain, IHC, immunofluorescence, and other special procedure slides and test data prepared and initially examined at the referring facility.

* Special procedures are separately chargeable with consult cases only if they’re prepared or repeated by the lab at which the consultant practices

* The number of slides, number of original specimens, existence and extent of special study slides and data, and general complexity are irrelevant to the determination that a particular case warrants classification as a “comprehensive” consult.

* The sole criterion is the presence of patient records beyond the outside pathologist’s report.

* Per the AMA CPT-IS (Information Services) {AMA CPT-IS, KB #1407,Oct. 29, 2007} Code 88325 includes a comprehensive review of the patient’s records. CPT neither defines nor states the minimum number or type of additional data sources qualifying the use of 88325. The requirement to review additional records can be considered as a surrogate for a higher level of work because additional patient information, beyond the referred anatomic pathology material and report, may be required to clarify the patient’s diagnostic issue. The descriptor nomenclature of 88325 indicates that the consultation involves additional material (more than just a cursory review); and that the consultation process is one that objectively integrates the information to arrive at a diagnosis in conjunction with the pathology specimens received. To substantiate the appropriateness of 88325, it is recommended that the report document that the outside material was incorporated into the process of arriving at a diagnosis, beyond just having received one or two reports or slides.

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