1. In the Pathology and Laboratory section, what additional items may be included with special reports?

A. Complexity of symptoms, final diagnosis, pertinent physical findings, diagnostic and therapeutic procedures, concurrent problems, follow-up care

B. Signs and symptoms, final diagnosis, follow-up care, concurrent problems, drug testing, pathology findings

C. Complexity of symptoms, final diagnosis, pathology findings, pertinent physical findings, diagnostic and therapeutic procedures, concurrent problems, follow-up care

D. Complexity of symptoms, final diagnosis, testing time, consultations notes, follow-up car

2. Brent had the following lab tests:

Calcium, ionized

Carbon dioxide

Chloride

Creatinine

Glucose

Potassium

Sodium

Urea Nitrogen (BUN)

How should you report Brent’s lab work?

A. 80048

B. 80047-52

C. 82310, 82374, 82435, 82565, 82947, 84132, 84295, 84520

D. 80047

3. Dr. Lee performed an intra-operative consultation on a bile duct tumor requiring frozen section and cytological evaluation to a bladder tumor. How would you report his professional services?

A. 88329B. 88331-26, 88334-26C. 88331, 88332 x 2

D. 88331-26, 88333-26

4. Which modifier would you use to report with code 88239 if the test was looking for hereditary breast cancer?

A. OB

B. 59

C. 91

D. OA

5. Marvin had a breath alcohol test completed at the hospital after the police arrested him for racing his four-wheeler past a McDonald’s drive through window. Marvin’s breath alcohol test was mathematically calculated. How would you report the calculation on this test?

A. 82075

B. 82075 x 2

C. 82075, 82355

D. 82355

6. Dr. Monday provided a comprehensive clinical pathology consultation at the request of Dr. Adams. This request was regarding a patient with various infections, drug allergies, skin rash, and Down’s syndrome. The patient is in the hospital intensive care unit being treated with intravenous antibiotics. Dr. Monday did not see the patient but he reviewed the patient’s history, complex medical records, and provided a written report back to Dr. Adams regarding his findings and recommendations for further treatment. How would Dr. Monday report his services?

A. 80502

B. 99244

C. 99244-25, 80502

D. 99255-25, 80500

7. A patient had a semi-quantitative urinalysis for infectious agent detection. How should you report this test?

A. 81050

B. 81005

C. 81099

D. 81005, 83518

8. Code 3011F describes which diagnostic or screening process?

9. Lipid panel results including total cholesterol, HDL-C, triglycerides, calculated LDL-C

10. Lipid panel results including total cholesterol

11. Lipid panel results including cholesterol, triglycerides, lipoprotein

12. Lipid panel results including cholesterol, triglycerides, carbon dioxide, glucose, potassium

9. A 58-year-old male patient with abdominal pain and episodes of bright red blood in his stool reports to his physician’s office for a check-up. His physician performs a digital rectal exam and tests for occult blood. Dr. Smith documents this blood occult test was done for purposes other than colorectal cancer screening. How would you report the occult blood test?

10. 82270

11. 82274

12. 82271

13. 82272

10. Kathy has had intermittent abdominal pain, occasional diarrhea, stool frequency, and bloating. Her symptoms have worsened over the past two months. Her physician orders a fecal Calprotectin test to check for Crohn’s disease. How should you report the lab test?

11. 82270

12. 82272, 83993

13. 83993

14. 82271, 82272

15. 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?

1. 88302, 88304 B. 88304-26, 88305-26

2. 88305-26, 88307-26 D. 88307, 88309

12. During a craniectomy the surgeon performed 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 a microscope was used to examine 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?

1. 80500 B. 88331-26 C. 80502 D. 88331-26, 88304-26

13. Physician orders a comprehensive metabolic panel but also wants blood work on calcium ions and also orders a basic metabolic panel. Select the code(s) on how this is reported.

1. 80053, 80047 B. 80053

2. 80047, 82040, 82247, 82310, 84075, 84155, 84460, 84450 D. 80053, 82330

3. 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 each single drug class using an immunoassay in a random access analyzer. Presence of antidepressants is found and a drug confirmation is performed to identify the particular antidepressant. What correct CPT® codes are reported?

A. 80101 x 3, 80102

B. 80100, 80102

C. 80101 x 3, 80102 x 3

D. 80100 x 3, 80102 x 3

15. 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 is reported for this testing?

A. 80101

B. 80102

C. 80201

D. 80201, 80102

16. 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) should be reported for this test?

A. 82947 x 5

B. 82946

C. 80422

D. 82951, 82952 x 2

17.A patient with severe asthma exacerbation has been admitted. The admitting physician orders a blood glass 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 reporting this service.

A. 82805, 82805-51

B. 82810, 82810-91

C. 82803, 82803-51

D. 82805, 82805-90

18. 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 codes for reporting this service.

A. 88248

B. 88267, 88280, 88285

C. 88273, 88280, 88291

D. 88262, 88285

19. 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

20. 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. 80502

D. 88329

21. A surgical specimen was removed from the proximal jejunum during a resection for adenocarcinoma and was submitted to surgical pathology for gross and microscopic examination. The correct code for this service is:

A. 88300 B. 88309

C. 88304 D. 88305

22. The physician performs the following tests on her automated equipment: HDL, total serum cholesterol, triglycerides and a quantitative glucose. The correct codes for these procedures are:

A. 83718, 82465, 84478, 82947 B. 83721, 82465, 82951

C. 80061, 82947 D. 80061, 82950

23. A patient with rheumatoid arthritis is being treated with gold. The physician orders a therapeutic drug test to measure the level of gold. What is the correct code?

A. 80172 B. 80100

C. 80102 D. 80299

24. A patient presents to the ED with crushing chest pain radiating down the left arm and up under the chin. There are elevated S-T segments on EKG. The cardiologist sees and admits the patient to CCU. He orders three serial CPK enzymes levels with instructions that the tests are also to be done with isoenzymes if the initial tests are elevated for that date of service. The CPK enzyme levels were elevated, the lab codes would be:

A. 82550, 82552, 82550-76 x 2, 82552-76 x 2 B. 82550, 82552, 82552-91 x 2

C. 82550, 82550-91 x 2, 82552, 82552-91 x 2 D. 82550 x 3, 82554 x 3

25. Which of the following panels does NOT include chloride?

A. 80061 B. 80050

C. 80053 D. 80047

26. The patient presents with burning urination and frequency. The physician performs a UA dipstick, which shows elevated WBC. He orders a urine culture with identification for each isolate to determine which antibiotic to give to the patient for the infection. What are the appropriate lab codes?

A. 81000, 81007 B. 81002, 87088

C. 81001, 87086 D. 87086, 87088

27. Which of the following coding combinations is an example of unbundling?

A. 80048, 80061 B. 80076, 80100

C. 80061, 83718, 84478 D. 82310, 82355, 82374

28. Patient is undergoing in vitro fertilization to get pregnant. Following the retrieval of follicular fluid

from the patient, the physician uses a microscope to examine the fluid to identify the ooctyes. What is the code for the laboratory service?

A. 89250 B. 89254

C. 89255 D. 89258

29. A patient has an iliac crest bone marrow biopsy. The physician suspects the patient has myelofibrosis. The bone marrow specimen is sent to pathology for gross and microscopic exam. What is the appropriate code for the pathologist’s service?

A. 88304 B. 88305

C. 88309 D. 88307

30. A pathologist performs a comprehensive consultation and report after reviewing a patient’s records, specimens and official findings from other sources. What is the correct code?

A. 88325 B. 99244

C. 80502 D. 88329

31. Which code(s) should be reported for the following case?

Clinical history: Mass in the body of stomach

Gross description: Cavity effusion – two Diff-Quik four smears prepared with simple filter and interpretation Specimen received: Stomach mass touch prep

Adequacy: Specimen satisfactory for cytological evaluation

Diagnosis: Primary malignant neoplasm – body of the stomach

Notes: Cytology completed on specimen. The malignant cells show subjective features suggestive of small-cell carcinoma; however, cell size is more attuned with non-small-cell carcinoma.

a. 151.4, 88107

b. 209.63, 88104

c. 789.30, 151.4, 88107

d. 209.63, 151.3, 88108

32. Dr. Ross, a pathologist, completed both gross and microscopic surgical pathology after a lung wedge biopsy. Dr. Miles, the surgeon, sent a single specimen to the laboratory after the completion of a limited biopsy by thoracotomy. How would Dr. Ross report her services?

a. 88300, 88307

b. 32151, 88305-26

c. 88307

d. 32095, 88307-26

33. Robert was sent to a local laboratory for pre-employment drug screening. He provided a urine sample to the laboratory technologist. The technologist completed a qualitative screening, including one procedure for multiple drug classes using non-chromatographic methods with a multiplexed kit. The test was negative and results were sent back to the requesting employer. How should you report this laboratory service?

a. 80102

b. 80100, 80101

c. 80103

d. 80104

34. Jane underwent a combined rapid anterior pituitary evaluation panel with multiple exposures and suppressions and had a hepatic function panel. How should these tests be reported?

a. 82024 x 4, 83002 x 4, 83001 x 4, 84146 x 4, 83003 x 4, 82533 x 4, 84443 x 4

b. 80418, 80076

c. 80418, 82024, 83002, 83001, 84146, 83003, 82533, 84443

d. 80076

35. Dr. Thomas received a request for consultation that included records and specimens. Dr. Thomas did not see the patient, but documented the patient as inpatient status with a comprehensive family history of colon cancer. The patient takes multiple medications and is at high risk of complications due to weight loss, chronic diarrhea, and a continued fever. His confirmative opinion, based on the review of specimens and records, indicates positive small-cell cancer. Dr. Thomas sent his written report back to the requesting physician. How should Dr. Thomas report his services?

a. 99254

b. 88325

c. 99254-25, 88325-26

d. 88323

29

36. Which modifier appended to code 88239 would describe solid tumor testing of Von Hipple–Lindau disease?

a. – 59

b. – 1Z

c. – 0F

d. – P6

37. Larry had a venipuncture during his annual physical examination. The blood sample was used for the following antibody tests: West Nile IgM, Shigella, mumps, and total hepatitis B. How should you report these tests?

a. 36415

b. 86486

c. 86788, 86771, 86735, 86704

d. 36415-32, 86788, 86771, 86735, 86704

38. Today, an extended culture of five-day embryos was completed. The transfer tests will be completed when the culture test results are confirmed. The culture testing results are scheduled for return within 48 hours. How should the culture service be reported?

a. 89272

b. 89250

c. 89258

d. 89255, 89272

39. A patient had the following blood tests completed as part of her primary care physician’s described metabolic panel: albumin, bilirubin total, calcium total, carbon dioxide, chloride, creatinine, glucose, phosphatase alkaline, potassium, protein total, sodium, transferase (ALT SGPT), transferase aspartate (AST SGOT), urea nitrogen (BUN), bilirubin direct, and a hepatitis A IgM. How should these services be reported?

a. 80053, 82248, 86709

b. 80053-22

c. 80076-52, 80074-52, 80053-52

d. 80047, 80053, 80076

40. A patient had glucose tolerance testing completed on five specimens. How should these laboratory services be reported?

a. 82947, 82951, 82952-51

b. 82951, 82952 x 2

c. 82947, 82952 x 5

d. 82951 x 5

ANSWERS

1. “a” You can find this answer at the beginning of the Pathology and Laboratory Guidelines of the CPT Professional Edition.

2. “d” The tests reported are listed under the basic metabolic panel code 80047. When reporting a panel, all the tests listed in the panel must be completed. If one test is missing, then you should not report a panel. If a panel is completed and there are additional test(s), then you would report the panel and the code(s) for the additional test(s). Do not add modifier -52 to panel codes to indicate that not all the tests in the panel were completed.

3. “b” The first parenthetical note following codes 88331 and 88334 give reporting instructions (us both codes).There are two tumor sites in this question.

4. “a” Genetic Testing Modifiers are listed in Appendix I of the CPT Professional Edition. The note under the subcategory Cytogenetic Studies refers to Appendix I.

5. “a” The math calculations are included (bundled) with chemistry tests. You can find this note in the last paragraph under the Chemistry subsection of the CPT Professional Edition.

6. “a” The code 80502 reports a comprehensive clinical pathology consultation. The patient was not present; therefore you would not report an evaluation and management consultation code.

7. “B”

8. “a” You can find this code in Category II codes..50

9. “d” The code 82272 states, “…performed for other than colorectal neoplasm screening.”

10. “c” You can find this test in the CPT Professional Edition under Calprotectin, fecal.

11. B The first specimen is found under code 88304-Artery, atheromatous plaque. The second specimen is found under code 88305-Skin, other than cyst/tag/debridement/plastic repair. Modifier -26 is appended to show the pathologist’s service.

12. B Since the pathology consultation of the tumor is performed during a surgery you are guided to code 88331. Codes 80500 and 80502 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. The pathologist did not perform the final report of the tumor, eliminating multiple choice answer D. Modifier -26 reports the professional service.

13 . D The young child was administered the Poliovirus vaccine by intramuscular route guiding you to code 90713 eliminating multiple choice B. The influenza vaccine was for intranasal route is code 90660 eliminating multiple choices A and D. For the administration codes the vaccines were administered without face-to-face counseling eliminating multiple choice answers A and B. The first vaccination was administered by the intramuscular route guiding you to code 90471. The second vaccine (additional vaccine) was administered by the intranasal route guiding you to code 90474. The third vaccine (additional vaccine) is given by the subcutaneous route guiding you to code 90472.

14. A To report codes for drug testing depends on the method and how many drug classes are to be tested. The scenario documents the method of the drug screening being performed by using an

immunoassay method on each single drug class, guiding you to code 80101. Each drug class is reported separately for this code meaning since there are three drug classes being tested you will report 80101 three times. A drug confirmation was performed for one drug, reporting code 80102 only once.

15. 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 answer A. Drug confirmation code, 80102, is only used with the drug testing codes not therapeutic drug assay codes according to CPT ® guidelines.

16.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.

17. 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 since 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 report 36600 for the arterial puncture.

18.B The chromosome analysis was taken from amniotic fluid eliminating multiple choices A, C and D. There were two karyotypes performed. Code 88267 only has one karyotype in its code description so code 88280 is reported for the additional karyotype. 30 cells were analyzed in which code 88285 is reported for the additional cells over the initial 15 cell count.

19. B 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). After this is done each egg is injected with sperm for fertilization. A needle is inserted through the egg’s outer shell into the cytoplasm of the egg for 10 oocytes or less (89280).

20. A In the CPT® index, look up Pathology/Surgical/Consultation. You are referred to 88321-88325. 88325 is the correct code. According to CPT® guidelines, “Code 88325 is used for a more comprehensive consultation on referred material that involves review of records and specimens.”

21. B. The encounter mentions that a specimen was removed from the proximal jejunum, which is part of the small intestines, during a resection for cancer. Code 88309 is the only lab code that covers the small intestine resection of a tumor.

22. C. The first three labs (HDL -87318, total serum, cholesterol-82465 and triglycerides-84478) are part of the lipid panel for code 80061. That leaves the lab, quantitative glucose, to be added with code 82947.

23. A. This is a therapeutic drug test, since the patient is taking gold for rheumatoid arthritis, and this type of drug test is found between codes 80150 – 80299. 80172 is the correct code since the physician wants to measure the level of gold found in the blood stream.

24. C. In this scenario, three CPK enzyme levels are performed. Modifier 91 is appended to the second, and third CPK CPT® to indicate the services were repeat clinical diagnostic tests. Since each of the CPK enzymes were elevated, the isoenzymes were also tested, which is reported with 82552. Modifier 91 is appended to the second and third test to indicate the tests are repeat clinical diagnostic tests.

25. A. In the panel section of the laboratory tests, look up each of the codes to determine the tests are included in the panel. 80061 is the only test that does not include chloride. 80050 includes a comprehensive metabolic panel (80053) which includes chloride.

26. B. First the physician performs a UA dipstick with no indication of a microscopic test. This test is reported with 81002. The urine culture is performed with identification for each isolate, which is reported with 87088. 87086 is a quantitative test for a colony which is incorrect.

27. C. Unbundling is reporting components of a code separately that can be reported with one code. In this case 80061 includes 83718 and 84478. It is unbundling to report components of a panel separately.

28. B. The identification of ooctyes in the follicular fluid is performed. The stage in this scenario does not include the culture or preparation of the oocyte, only the identification of them. This service is reported with 89254.

29. B. The appropriate code is determined by the type of specimen. In this case the specimen is a bone marrow biopsy. Under each code in this section of CPT® is a list of specimens for each code. For this scenario, the correct answer is 88305 because it is specific for bone marrow. 88304 is reported for bone fragments which is not correct. 88307 is reported for a bone biopsy. 88309 is reported for bone resection.

30. A. The pathologist services are not reported with E/M codes, which eliminates answer option B. 80502 is clinical consultation requested by an attending physician for the pathologist medical interpretive judgment, which is not described in this scenario. The service is not performed during surgery, which eliminates D as a correct answer. The code description for 88325 matches the scenario in the question making it the correct answer.

31. a. The diagnosis code is reported from the diagnosis description section of this report or the definitive findings. The clinical history indicates why the cytology is being evaluated. The procedure code is reported with the simple filter preparation and interpretation as stated in the question.

32. c. The specimen evaluated in this question was from a lung wedge biopsy. Review the codes in the surgical pathology section based on anatomy and/or location of the specimen, absence or presence of disease reported, and/or physician’s description of specimen received and studied.

33. d. This is a new code for 2011 and is out of numerical sequence; therefore, there are two symbols listed with this code. Additionally, the parenthetical notes in the CPT® Professional Edition below code 80101 assist with selection of testing with multiplexed screening methods.

34. b. One way to find this code in the index of the CPT® Professional Edition is under the main term “Evocative/ Suppression Test.” Review of the code range provided will lead to the combined rapid anterior pituitary evaluation panel. This panel code includes all the codes listed with the panel.

35. b. This service is a comprehensive consultation with review of records and specimens. Dr. Thomas did not see the patient in this question; therefore, an evaluation and management code is not reported.

36. c. The CPT® Professional Edition includes a list of modifiers for genetic testing. Review Appendix I for these modifiers. Additionally, the subcategory notes with cytogenetic studies refer to Appendix I for modifiers.

37. c. One way to find these codes in the CPT® Professional Edition is under the main term “Antibody,” then look for specific tests.

38. a. This question focuses on the culture and days of the embryos. The transfer code would be reported on the date of that service. (The ability to select pertinent information from exam questions is a key factor to successful test taking. To build testing skills, try reading the last sentence first to figure out what is being asked in the question, then focus on that information.)

39. a. Review of the subcategory guidelines in the CPT® Professional Edition under the heading “Organ or Disease-Oriented Panel” provides assistance with code selection. These notes indicate that the use of panel codes includes the tests within a specific panel; however, additional tests should be reported as necessary.

40. b. The parenthetical notes provided with add-on codes, such as code 82952, are helpful when determining code selection and reporting.