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CPT® and RBRVS 2011 Annual Symposium November 10-12, 2010

Pathology and Laboratory

Presented by Mark S. Synovec, MD, AMA-CPT Editorial Panel

Pathology and Laboratory Subsection Overview

Drug Testing Chemistry Hematology and Coagulation Immunology Transfusion Medicine Microbiology Cytopathology Surgical Pathology In Vivo (eg,Transcutaneous) LaboratoryProcedures

Pathology and Laboratory/ Drug Testing

#· 80104 Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure

(For qualitative analysis by multiplexed screening kit for multiple drugs or drug classes, use 80104) 80104 has same descriptor language as G0430!

Point of Service Drug Screening Kits Galore!!!

Chemistry

82926 Gastric acid, free and total, each specimen 82928 Gastric acid, free or total, each specimen (82926, 82928 have been deleted) (For gastric acid analysis, use 82930)

·

82930

Gastric acid analysis, includes pH if performed, each specimen

Chemistry

82951 Glucose; tolerance test (GTT), 3 specimens (includes glucose) tolerance test, each additional beyond 3 specimens

82952

(List separately in addition to code for primary procedure) (Use 82952 in conjunction with 82951)

Chemistry

· 83861

Microfluidic analysis utilizing an integrated collection and analysis device, tear osmolarity

(For microfluidic tear osmolarity of both eyes, report 83861 twice)

Tear Analysis by Direct Nanoliter Specimen Collection Utilizing Labon-a-Chip Technology

In clinical practice, tears are collected directly from the inferior lateral tear meniscus.

The single-use, disposable polycarbonate microchip. The channel collects 50 nanoliters (nL) of tear fluid directly by passive capillary action.

www.TearLab.com/library/09/930074RevA.pdf

Chemistry

· 84112

Placental alpha microglobulin-1 (PAMG-1), cervicovaginal secretion, qualitative

Placental alpha microglobulin-1 (PAMG-1)

Qualitative test for the detection of amniotic fluid in vaginal secretions, using immunochromatography to detect human PAMG-1 (placental a-1 microglobulin) protein present in amniotic fluid of pregnant women. Placental Microglobulin is a marker of fetal membrane rupture due to its high level in the amniotic fluid, low level in blood, and extremely low background level in cervico-vaginal secretions when the fetal membranes are intact.

www.sidelines.org

Hematology and Coagulation

85597 Platelet Phospholipid neutralization; platelet

· 85598

hexagonal phospholipid

Immunology

86480 Tuberculosis test, cell mediated immunity antigen response measurement ; of gamma interferon antigen response enumeration of gamma interferon-producing T-cells in cell suspension

· 86481

Three choices for testing progressionrisk, immuno-suppressed individuals for Latent TB infections exist:

1) the tuberculin skin test (PPD) ­ new tests are available with higher sensitivity and reliability for this population 2) an ELISA-based IFN release assay (IGRA) ­ (eg, Quantiferon)* 3) an ELISPOT-based IFN release assay ­ (eg, T-SPOT.TB)* *These tests have specific and different FDA instructions and have different laboratory methodologies/costs.

Transfusion Medicine

· 86902 Blood typing; antigen testing of donor blood using reagent serum, each antigen test Blood typing; antigen screening for compatible blood unit using reagent serum, per unit screened

86903

(If multiple blood units are tested for the same antigen, 86902 should be reported once for each antigen for each unit tested) (86903 has been deleted. To report, use 86902)

Transfusion Medicine

86965 Pooling of platelets or other blood products (For injection(s) of platelet rich plasma, use 0232T)

Microbiology

· 87501 Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, reverse transcription and amplified probe technique, each type or sub-type Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, reverse transcription and amplified probe technique, first 2 types or sub-types

· 87502

Microbiology

· 87503 Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, each additional influenza virus type or subtype beyond 2 (List separately in addition to code for primary procedure)

(Use 87503 in conjunction with 87502)

Microbiology

87901 Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV-1, reverse transcriptase and protease regions HIV-1, other region (eg, integrase, fusion)

#· 87906

Cytopathology

· 88120 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, 3-5 molecular probes, each specimen; manual using computer-assisted technology

· 88121

(For morphometric in situ hybridization on cytologic specimens other than urinary tract, see 88367, 88368) (For more than 5 probes, use 88399)

Bladder Cancer Kit

CEP 3 (3p11.1-q11.1) CEP 7 (7p11.1-q11.1) LSI (p16 9p21) Red Green Gold

CEP 17 (17p11.1-q11.1) Aqua

Aneusomic interphase cell obtained from a sample showing two copies of chromosome 3 (red), four copies of chromosome 7 (green), five copies of chromosome 17 (aqua) and one copy of p16 gene (gold) after the hybridization testing performed with the bladder cancer kit.

Cytopathology

88120 - Description of Physician Work

· The pathologist must focus up and down to be sure he/she is observing all the signals for that probe in that nucleus. · The number of signals is recorded on a worksheet and the process repeated for the other 3 filters or probes. · The pathologist selects one or two representative cells to take a digital fluorescence micrograph, a regulatory requirement. · The pathologist then transfers these images to the laboratory information system for later inclusion in the report. From the probe signal counts recorded on the worksheet and micrographs the pathologist prepares the report.

Cytopathology

88121 - Description of Physician Work

· Same physician work except with use of a computer assisted system · Using the computer assisted system, the pathologist can scan and perform an analysis of the entire slide. · With the use of FDA-approved systems, images of the cells can be taken and placed side by side, then displayed in a tile-like fashion on a computer screen. · The computer assists in the process counting the number of signals from the probe, and the number of signals is recorded in the system and the process is repeated for the other 3 filters or probes. · The pathologist selects one or two representative cells to capture a digital fluorescence micrograph, a regulatory requirement. · The pathologist then transfers the images to the laboratory information system for later inclusion in the report. From the probe signal counts recorded and micrographs the pathologist prepares the final report.

Cytopathology

88120-88121 ­ Work RVU's · 88120 (manual) work RVU = 1.20

(compared to prior assignment of 88368x4 1.40 x 4= 5.60)

· 88121 (computer assisted) work RVU = 1.00

(compared to prior assignment of 88367x4 1.30 x 4= 5.20)

Cytopathology

88172 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy of specimen(s) for diagnosis, first evaluation episode, each site (The evaluation episode represents a complete set of cytologic material submitted for evaluation and is independent of the number of needle passes or slides prepared. A separate evaluation episode occurs if the proceduralist provider obtains additional material from the same site, based on the prior immediate adequacy assessment, or a separate lesion is aspirated)

Cytopathology

(Report one unit of 88173 for the interpretation and report from each anatomic site, regardless of the number of passes or evaluation episodes performed during the aspiration procedure)

Cytopathology

# · 88177 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, each separate additional evaluation episode, same site (List separately in addition to code for primary procedure) (When repeat immediate evaluation episode(s) is required on subsequent cytologic material from the same site, eg, following determination the prior sampling that was not adequate for diagnosis, use 1 unit of 88177 for each additional evaluation episode) (Use 88177 in conjunction with 88172)

Cytopathology 88172 & 88177 Physician work (cont):

· The pathologist performs a microscopic examination of each slide and determines that either the material is adequate or that additional aspirate material is needed for diagnosis and/or definitive workup. · The pathologist communicates this information to the radiologist. · 88172 work RVU = 0.60 (CMS maintained current

value)

· 88177 work RVU = 0.42

Surgical Pathology Base Codes

· 88300 - Level I - Surgical pathology, gross examination only, work RVU = 0.08 · 88302 - Level II - Surgical pathology, gross and microscopic examination, work RVU = 0.13 · 88304 - Level III - Surgical pathology, gross and microscopic examination, work RVU = 0.22 · 88305 - Level IV - Surgical pathology, gross and microscopic examination, work RVU = 0.75 · 88307 - Level V - Surgical pathology, gross and microscopic examination, work RVU = 1.59

Surgical Pathology Base Codes: 88300, 88302, 88304, 88305, & 88307

· These services were identified by the RUC's Relativity Assessment Workgroup through its CMS screen for Harvard-valued codes with utilization greater than 1 million. · The College of American Pathologists conducted a standard RUC Survey for each of the pathology consultation codes · The survey data demonstrated that the current work associated with these services is accurate and furthermore supports the specialty society's recommendation that there was no compelling evidence to change the current work of these services.

Surgical Pathology

88332 Pathology consultation during surgery; each additional tissue block with frozen section(s) (List separately in addition to code for primary procedure)

(Use 88332 in conjunction with 88331)

Surgical Pathology

88334 Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), each additional site (List separately in addition to code for primary procedure)

(Use 88334 in conjunction with 88331, 88333)

Surgical Pathology

· 88363

Examination and selection of retrieved archival (ie, previously diagnosed) tissue(s) for molecular analysis (eg, KRAS mutational analysis)

88363 - Archival Retrieval for Mutational Analysis

· After verifying that the patient has tissue samples in the pathology archives, the pathologist reviews the reports and examines the slides and blocks from the relevant specimens to determine which has the richest and most representative area of non-necrotic tumor for KRAS analysis, such to be sent to an appropriate reference testing laboratory. · The service does not include the molecular diagnostic interpretation or microdissection. · The physician (pathologist) will document the review of the pertinent pathology reports and slides and selection of the appropriate material for submission. · 88363 work RVU = 0.37

In Vivo (eg, Transcutaneous) Laboratory Procedures

· 88749 Unlisted in vivo (eg, transcutaneous) laboratory service (For all in vivo measurements not specifically listed, use 88749) (For wavelength fluorescent spectroscopy of advanced glycation end products (skin), use 0233T)

Deleted Codes

89130 Gastric intubation and aspiration, diagnostic, each specimen, for chemical analyses or cytopathology; 89132 89135 89136 after stimulation 1 hour two hours

89140 two hours including gastric stimulation (eg, histalog, pentagastrin) 89141 three hours, including gastric stimulation

Codes 89130-89141 have been deleted. To report, see 43754, 43755

Deleted Codes

89100 Duodenal intubation and aspiration; single specimen (eg, simple bile study or afferent loop culture) plus appropriate test procedure 89105 collection of multiple fractional specimens with pancreatic or gallbladder stimulation, single or double lumen tube Codes 89100-89105 have been deleted. To report, see 43756, 43757

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