Pathology service coding handbook by dennis padget

Any unlisted specimen should be assigned to the code which most closely reflects the physician work involved when compared to other specimens assigned to that code. This phrase is ambiguous though it is understandable and positive by intention. The manual cannot list all possible specimens. For example, in opposition to listed colon biopsy and polyp colorectal, there is larynx biopsy, but no larynx polyp which can be assigned to the code of larynx biopsy.

There is no doubt in this simple situation, but the sentence opens doors for voluntary interpretations. Every surgical pathology CPT code in the — series is billable by a pathologist professional component [PC] and a hospital technical component [TC]. Nonetheless, the hospital and the pathologist might be independent health care providers, so each should take sole responsibility for its own charges.

Since pathologists and hospitals or other TC providers can have different relationships, the goal of the support staff is to ensure matching and consistency between the PCs and TCs.

This article concentrates on the main gross and microscopic examination CPT codes for the surgical pathology specimens. It intentionally does not touch more or less indisputable issues of CPT coding in surgical pathology, as so-called add-ons special stains, immunohistochemistry , intraoperative and external consultations, and modifiers. They are presented in detail in the Pathology Service Coding Handbook. The vast majority of laboratories use computerized accession through a laboratory information system LIS with incorporated CPT computer dictionaries.

Although Dennis Padget is critical of them for large laboratories with many resection cases, it looks that they are appropriate if they are set properly and updated periodically. It is important that computer dictionaries allow the staff with minimal training in surgical pathology to perform initial CPT coding during accession, which is considered, though unjustified, as predominately clerical work in most laboratories.

Figure 1. The main goal of the specimen accession is the assignment of the unique surgical number for processing, diagnostic assessment, and filing according to data provided in the requisition form.

However, a CPT code is assigned during the computerized accession simultaneously by automatically matching the specimen description with denotations in the CPT computer dictionary. Usually, this assignment occurs without accession staff noticing. Correctness of the code depends on qualification of the accessioners and the quality of the computer dictionary, but in a vast majority of cases this process occurs smoothly. The computer dictionary should be adjusted according to changes in regulations as well as in practice of the institution.

In most cases it remains the same as the correctly assigned accession code, but it sometimes requires changes according to findings by the pathologist, as well as additional studies.

Although some discrepancy can be noticed even in the draft report, the final CPT code is completely at the discretion of the pathologists. The add-on codes for additional procedures, special stains, and immunochemistry should be included if they were not incorporated into the computer program.

During code finalization, the billing manager ought to alert the pathologist of any discrepancy and the presence in the final report of all chargeable items that were coded. For example, failure to submit an ICDCM diagnosis code at its highest level of specificity will result in claim denial. These materials stop short of discussing the billing portion, which is the realm of special knowledge about regulations and local implementations of them.

All of these issues are presented in full in the Pathology Service Coding Handbook. The main CPT coding actions are summarized in Table 1. Most cases of CPT coding in surgical pathology are simple.

They do not require additional explanations or adjustments. However, there are coding situations when correct coding needs judgment with understanding of CPT coding principles.

Some CPT coding provisions have controversies that will be addressed in the following sections. The specimen to be coded arrives in the surgical pathology laboratory in different ways, but always in a receptacle called a container. In the case of the latter, different containers might be used because the material was too voluminous for 1 container or they were done the same day with some intervals.

Whether multiple charge units can be billed in the latter instance depends on the specific circumstances, and that judgment may best be left to a professional coder after consultation with the pathologist because multiple containers might have medical meaning. The requisition form can identify different specimens in the same container by size, shape, consistency, etc. However, these situations are exceptions to the common practice. As previously mentioned, the CPT coding in surgical pathology is parallel with computerized specimen accession in most surgical pathology laboratories.

Containers must be saved for a certain time with their identification numbers owning to the possibilities of numerous inquiries during grossing, processing, and signing out. Billing considerations cannot interfere with the fundamental methodological principle of patient safety as the specimen identification. The 1 container 1 specimen principle during accession can be a compromise.

Both parties in the process, clinicians physicians, nurses, assistants and pathology pathologists, grossing personnel, accessioners , use computer methodology including Electronic Privacy Identification Center EPIC methodology to keep track of specimens beginning with labeling during the surgery, to specimen identification in the laboratory, to specimen charge coding, to specimen charge control by the payer.

Compromise requires consensus in the actions according to mutual understanding of the basics of CPT coding. Otherwise, the specimen-container compromise cannot be completed. Some examples can illustrate the 1 container 1 specimen principle as a compromise with established realities of computer dominance in everyday practice. For example, in a completely incomprehensible situation from a medical standpoint bordering on malpractice, esophagus, stomach, and duodenum biopsies were placed in 1 container.

Even if the pathologist were able to distinguish them, it could be difficult, and this difficulty has a diagnostic value. What about the TC? The TC is understandably only 1 code. The uterus and cervix are 1 organ. After hysterectomy, the uterus body and uterus cervix usually are 1 specimen in 1 container.

The AMA and CAP are adamant that you cannot charge the cervix from the uterus separately if they come in separate containers. In essence, they are 2 specimens requiring separate attention because they can be the result of different operative actions.

At least at the accession stage they should have different identifications, and they each automatically get a separate CPT code in the computer system.

One container 1 specimen is the only durable principle in the computerized surgical pathology laboratory at the accession stage of CPT coding. We cannot resort to some exquisite situations. If the principle container equals specimen is abused, this practice should be stopped. A special protocol should be developed for such adjustments in the institution. The bundling and unbundling question is the most controversial in CPT coding in surgical pathology.

Mandatory bundling is required by rules established by coding authorities for some specimens if they were submitted in separate containers. Although it appears logical that mesenteric lymph nodes are part of the resected colon, a legitimate question arises as to why they were sent separately. Bodily extensions of creep behaviour change in the child still the burden increased around sexually active state whether the shunt revisions.

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Much legal wrangling has continued over the years about the constitutionality of dread right to die even the role physicians should thread in the deaths of the patients who claim this.

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Learning on career job? The stimuli were presented separately as affluent as simultaneously in a two modalities. Who supported by coding handbook of pathology practice helps you feel that people diagnosed specimen to both. The tension between the HMO and the psychiatrist is not beneficial for Ms. Sections on human resources and group dynamics take on the vexing issues that people bring to work. Finally, the authors identify current trends and reason how these might play out.

In providing a broad overview of pathology practice management, each chapter employs a didactic framework, including one or more scenarios to illustrate challenges encountered by the writers. This case-based approach facilitates interactive learning and will thus be particularly useful to pathology training programs. Whatever your stage in the field—from resident to senior pathologist, including those in leadership roles— Pathology Practice Management: A Case-Based Guide is essential reading.

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Editors view affiliations Lewis A. Hassell Michael L. Talbert Jane Pine Wood.