Laboratory CPT Codes

Laboratory CPT Codes

Laboratory CPT codes and pathology CPT codes include services primarily reported to evaluate specimens obtained from patients (body fluids, cytological specimens, or tissue specimens obtained by invasive/surgical procedures) in order to provide information to the treating physician. This information, coupled with information obtained from history and examination findings and other data, provides the physician with the background upon which medical decision making is established.  Many laboratory tests are what a patient might call a ‘blood test,’ but laboratory tests rely on specimens of different bodily fluids.

When structuring test menus, it is a good idea to segment them by industry-Standard subsections.

CPT Codes for Laboratory Testing are Organized into Subsections

I. Organ or Disease Panels Subsection

80048 – 80081 panels of defined components for coding purposes only

II. Drug Testing Subsection Laboratory CPT Codes

Clinical drug testing is the process of analyzing plasma (serum) or urine to detect the presence or absence of a drug or its metabolites. As the metabolization rate of drugs differs, the window of detection for certain drugs or metabolites varies. Clinical drug testing plays an important role in the management of poisonings because the self-report of the drugs that have been taken is often unreliable. The same is true in the treatment of addiction disorders because clinical examination, patient self-reporting, and hetero-anamnesis will underreport the actual incidence of substance use.

Drug testing can be indicated in cases of suspected overdose or when monitoring abstinence in patients treated for addiction or in pain management clinics. No universal standard exists today in clinical drug testing for addiction identification, diagnosis, treatment, medication monitoring, or recovery. Guidelines exist for laboratory analyses for poisoned patients.

See Verstraete AG, Mukhdomi T. Clinical Drug Testing. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan.  See also Thompson JP, Watson ID, Thanacoody HK, Morley S, Thomas SH, Eddleston M, Vale JA, Bateman DN, Krishna CV. Guidelines for laboratory analyses for poisoned patients in the United Kingdom. Ann Clin Biochem. 2014 May;51(Pt 3):312-25 and Wu AH, McKay C, Broussard LA, Hoffman RS, Kwong TC, Moyer TP, Otten EM, Welch SL, Wax P., National Academy of Clinical Biochemistry Laboratory Medicine. National academy of clinical biochemistry laboratory medicine practice guidelines: recommendations for the use of laboratory tests to support poisoned patients who present to the emergency department. Clin Chem. 2003 Mar;49(3):357-79

Laboratory CPT Codes 80305 – 80377 divided into three sections

  • Presumptive drug class screening
    • Identifies possible use or non use of drug
    • Any specimen type; urine, blood test, oral fluid
  • Definitive drug testing
    • Qualitative or quantitative
    • Identifies possible use or non-use of a specific drug and metabolites
    • Any specimen type; urine, blood test,oral fluid
  • Therapeutic drug assays
    • Quantitative
    • Specimen typically is whole blood test, serum, plasma, cerebrospinal fluid

III. Evocative/ Suppression Testing Subsection

Evocative/suppression testing involves administration of agents to determine a patient’s response to those agents (CPT codes 80400-80440 are to be used for reporting the laboratory components of the testing). When the test requires physician administration of the evocative/suppression agent as described by HCPCS/CPT codes 90760-90775 and C8950-C8952 (therapeutic/diagnostic injections/infusions), these codes can be separately reported. However, when physician attendance is not required, and the agent is administered by ancillary personnel, these codes are not to be separately reported. In the inpatient setting, these codes are only reported if the physician performs the service personally. In the office setting, the service can be reported when performed by office personnel if the physician is directly supervising the service. While supplies necessary to perform the testing are included in the testing, the appropriate HCPCS J codes for the drugs can be separately reported for the diagnostic agents. Separate evaluation and management services are not to be reported, including prolonged services (in the case of prolonged infusions) unless a significant, separately identifiable service is provided and documented.  See CHAPTER 10, Version 12.3 CHAPTER X PATHOLOGY / LABORATORY SERVICES CPT CODES 80000 – 89999 FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES

Laboratory CPT Codes 80400 – 80439

  • Evocative or suppression agents are administered by a physician
  • These codes are used to report the laboratory component of the overall testing protocol
  • 80400 ACTH stimulation panel; for adrenal sufficiency
  • The panel must include Cortisol,

IV. Consultations/ Clinical Pathology Subsection CPT Codes

The CPT codes 80500 and 80502 are used to indicate that a pathologist has reviewed and interpreted, with a subsequent written report, a clinical pathology test. These codes additionally are not to be used with any other pathology service that includes a physician interpretation (e.g., surgical pathology). If an evaluation and management service (face-to face contact with the patient) takes place by the pathologist, then the appropriate E&M code is reported, rather than the clinical pathology consultation codes, even if, as part of the evaluation and management service, review of the test result is performed. Reporting of these services (CPT codes 80500 and 80502) requires the written order for consultation by a treating physician.  See CHAPTER 10, Version 12.3 CHAPTER X PATHOLOGY / LABORATORY SERVICES CPT CODES 80000 – 89999 FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES

Laboratory CPT Codes 80500 – 80502

  • Clinical pathology consultation rendered by a pathologist in response to a physician request

V. Urinalysis Subsection

CPT Codes 81000 – 81099

  • Clinical testing of urine constituents
  • Codes differ by testing method
    • Automated vs non automated
    • With or without microscopy

Includes test codes for urine pregnancy, specific analyte, and total volume measurement

VI. Molecular Pathology

Molecular pathology as applied to neoplasia is a rapidly expanding component of the discipline of pathology that uses molecular biology tools in addition to conventional morphologic, immunohistochemical and chemical analyses of abnormalities in tissues and cells to understand the etiology and pathogenesis of tumors, establish their diagnosis, and contribute to prognostication and therapeutic decisions for cancer patient care. The discipline of molecular pathology thus contributes throughout the continuum of biomarker research leading to incorporation into standard‐of‐care personalized cancer therapy. This continuum includes discovery; assessment of viability and feasibility; planning; development, integration and verification; validation including clinical trials; launch readiness and release; application in patient care, and subsequent post‐implementation evaluation of performance (Phillips et al., 2006).  See also Hamilton S. R. (2012). Molecular pathology. Molecular oncology6(2), 177–181.

Laboratory CPT Codes 81105 – 81479 Divided Into Four Sections

  • All involve analysis of nucleic acid (DNA, RNA) to detect variants in genes that may indicate
    • Germline condition – constitutional disorder
    • Somatic condition – neoplasia
    • Histocompatibility antigens
  • Code selection is based on the specific gene(s) being analyzed
  • Includes all analytic services (e.g., cell lysis, nucleic acid stabilization, extraction)
  • All analyses are qualitative unless otherwise noted

Molecular Pathology Subsection

Laboratory CPT Codes 81105 to 81383 – Tier 1

  • Codes for commonly performed gene specific and genomic procedures; single test corresponds to a single CPT cod

84100 to 81408 – Tier 2

  • Less commonly performed single gene • tests, organized into 9 ascending levels of technical work and resources

81410 to 81471 – Genomic Sequencing Procedures

  • Next-generation sequencing (NGS),specified by methodology

81490 to 81599 – Multianalyte Assay by Algorithmic Analysis

  • MAAAs that analyze multiple biomarkers with application of a proprietary algorithm to obtain a risk score

VII. Chemistry

Laboratory CPT Codes 82000 – 84999 – Specimen may be any source unless stipulated in code descriptor

84165 Protein; electrophoretic fractionation and quantitation, serum

84166 electrophoretic fractionation and quantitation, other fluids with concentration (e.g., urine, CSF)

VIII. Hematology and Coagulation Subsection

These tests include blood tests.  Hematology is the study of blood and blood disorders. Hematologists and hematopathologists are highly trained healthcare providers who specialize in diseases of the blood and blood components. These include blood and bone marrow cells. Hematological tests can help diagnose anemia, infection, hemophilia, blood-clotting disorders, and leukemia.

Laboratory CPT Codes 85002 – 85999

  • Hematology codes (85004 – 85049) describe variations of specific component(s) and methodology(s) used to obtain measurements of component parts of a complete blood count (CBC)
    • Red blood cell count (RBC)
    • White blood cell count (WBC)
    • Hemoglobin (Hgb)
  • Coagulation codes (85130 – 85999) describe variations of specific component(s) and methodology used to measure blood clotting abilities
    • Clotting factors, such as factor 7
    • Clotting inhibitors
    • Heparin assay

IX. Immunology Subsection

Laboratory CPT Codes 86000 – 86804

Immunology tests the components of the immune system whether immunity from disease, the immune response (allergy), or the development of antibodies to oneself (autoimmune)

  • Allergy tests, e.g., cat dander, oak pollen, or dust mites
  • Antibody-specific tests, e.g., Exposure to certain disease, such influenza, mumps, or rubella

X. Transfusion Medicine Subsection

Laboratory CPT Codes 86805 – 86999

  • Procedures for testing blood antigens and antibodies for blood transfusions during/after surgery or for testing mother/baby compatibility
  • Procedure codes for infusion of blood products such as fresh frozen plasma, platelets, white cells and red cells

XI. Microbiology Subsection

Unlike other areas of the diagnostic laboratory, clinical microbiology is a science of interpretive judgment that is becoming more complex, not less. Even with the advent of laboratory automation and the integration of genomics and proteomics in microbiology, interpretation of results still depends on the quality of the specimens received for analysis whether one is suspecting a prokaryote or a eukaryote as the etiologic agent, both of which are featured in this document. Microbes tend to be uniquely suited to adapt to environments where antibiotics and host responses apply pressures that encourage their survival. A laboratory instrument may or may not detect those mutations, which can present a challenge to clinical interpretation. Clearly, microbes grow, multiply, and die very quickly. If any of those events occur during the preanalytical specimen management processes, the results of analysis will be compromised and interpretation could be misleading.

Physicians and other advanced practice providers need confidence that the results provided by the microbiology laboratory are accurate, significant, and clinically relevant. Anything less is below the community standard of care for laboratories.  See Miller, J. M., Binnicker, M. J., Campbell, S., Carroll, K. C., Chapin, K. C., Gilligan, P. H., Gonzalez, M. D., Jerris, R. C., Kehl, S. C., Patel, R., Pritt, B. S., Richter, S. S., Robinson-Dunn, B., Schwartzman, J. D., Snyder, J. W., Telford, S., 3rd, Theel, E. S., Thomson, R. B., Jr, Weinstein, M. P., & Yao, J. D. (2018). A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America67(6), e1–e94.

Laboratory CPT Codes 87003 – 87999

  • Presumptive testing is the identification of colony morphology, growth on selective media, Gram stains or up to 3 tests (e.g., catalase, oxidase, indole)
  • Definitive testing is the ID of genus or species that requires tests (e.g., biochemical panel)
  • If additional studies to ID the organism involve the use of molecular probes, nucleic acid sequencing or immunologic techniques, codes 87140 – 87158 should be used.
  • Molecular diagnostic codes 81105 to 81408 are not to be used in combination with or instead of the procedures represented by codes 87140 – 87158.

XII. Cytopathology Subsection

Cytopathology is a diagnostic technique that examines cells that have been exfoliated (shed), scraped from the body or aspirated with a fine needle. Cell specimens are processed into slides and examined microscopically for the diagnosis of cancer, precancerous conditions, benign tumors and some infectious conditions.  See Stanford Medicine. About Cytopathology.

Laboratory CPT Codes 88104- 88199

  • Use of specialist diagnostic techniques to examine individual cells extracted from tissues to determine the cause and nature of a disease
  • Codes are separated by procedures
    • Cervical or vaginal cytopathology- 88141,88155,88164-88167,88174-88175
    • Cytopathology of fluids, washings, and brushings – 88104-88121
    • Cytopathology of fine needle aspirates – 88172-88177
    • Flow cytometry – a technique used to analyze the physical and chemical characteristics of particles (cells) in a fluid as it passes through at least one laser; 88182 – 88189

XIII. Cytogenetic Studies Subsection Laboratory CPT Codes

Clinical cytogenetics is the study of the relationship of chromosomal alterations and genetic diseases in human beings. Molecular cytogenetics is a study of genetic disorders using new technologies that combine cytogenetic and molecular techniques (Speicher and Carter, 2005).  See Li, M., & Pinkel, D. (2006). Clinical cytogenetics and molecular cytogenetics. Journal of Zhejiang University. Science. B7(2), 162–163.

Laboratory CPT Codes 88230 – 88299

  • The study of how chromosomes relate to cell behavior
  • Samples include tissue, blood, and bone marrow
  • Cells are grown in the lab to look for changes in chromosomes, including broken, missing, or extra chromosomes
  • Changes in certain chromosomes may be a sign of a genetic disease or condition or some types of cancer
  • May help diagnose a disease or condition, plan treatment, or find out how well treatment is working

XIV. Surgical Pathology Subsection

Surgical pathologists have the definitive role in tumor diagnosis. No matter how high the index of clinical suspicion, the diagnosis of cancer is not conclusively established nor safely assumed in the absence of a tissue diagnosis. With very few exceptions, definitive therapy for cancer should not be undertaken in the absence of a tissue diagnosis. Policies supporting this practice are written into the bylaws of most hospitals and are regularly monitored by hospital tissue committees and by accrediting agencies.

It is the task of the surgical pathologist to provide an accurate, specific, and sufficiently comprehensive diagnosis to enable the clinician to develop an optimal plan of treatment and, to the extent possible, estimate prognosis. There was a time not many years ago when the simple designation “benign” or “malignant” provided the clinician with all of the information necessary to provide appropriate care for the patient. This is no longer the case. Cancer is not a single disease. There are more than 300 distinct varieties of tumors, each with a characteristic biology.   See Connolly JL, Schnitt SJ, Wang HH, et al. Role of the Surgical Pathologist in the Diagnosis and Management of the Cancer Patient. In: Kufe DW, Pollock RE, Weichselbaum RR, et al., editors. Holland-Frei Cancer Medicine. 6th edition. Hamilton (ON): BC Decker; 2003.

Laboratory CPT Codes 88300 – 88399

  • Gross and microscopic (G&M) examination of specimens for abnormalities – 88300-88309
    • Specimen is defined as tissue or tissues that is/are submitted for individual and separate attention, requiring individual examination and pathologic diagnosis
    • 88300 ” … is used for any specimen that in the opinion of the examining pathologist can be accurately diagnosed without microscopic examination”
    • 88302 ” … is used when [G&M] examination is performed to confirm identification and absence of disease”
    • 88304 – 88309 “describe all other specimens requiring [G&M] and represent additional levels of physical work”

Laboratory CPT Codes for Ancillary services – 88311-88388

  • Special stains
  • lntraoperative consultations

XV. In Vivo Subsection Laboratory CPT Codes

Laboratory CPT Codes 88720 – 887 49

  • Transcutaneous procedures – measures analyte through the skin rather than using blood specimen
  • Used mostly for fetal monitoring
    • Bilirubin
    • Hemoglobin
    • Carboxyhemoglobin – Measurement of carbon monoxide
    • Methemoglobin – Abnormal form of oxygenated hemoglobin that cannot deliver oxygen to the tissues

Related Topics

Medical Billing Expert Witness

Medical Coding Expert Witness

Laboratory Test Expert Witness

Esoteric Tests

CLIA

Michael F. Arrigo

Michael is Managing Partner & CEO of No World Borders, a leading healthcare management and IT consulting firm. He serves as an expert witness in Federal and State Court and was recently ruled as an expert by a 9th Circuit Federal Judge. He serves as a patent expert witness on intellectual property disputes, both as a Technical Expert and a Damages expert. His vision for the firm is to continue acquisition of skills and technology that support the intersection of clinical data and administrative health data where the eligibility for medically necessary care is determined. He leads a team that provides litigation consulting as well as advisory regarding medical coding, medical billing, medical bill review and HIPAA Privacy and Security best practices for healthcare clients, Meaningful Use of Electronic Health Records. He advises legal teams as an expert witness in HIPAA Privacy and Security, medical coding and billing and usual and customary cost of care, the Affordable Care Act and benefits enrollment, white collar crime, False Claims Act, Anti-Kickback, Stark Law, physician compensation, Insurance bad faith, payor-provider disputes, ERISA plan-third-party administrator disputes, third-party liability, and the Medicare Secondary Payer Act (MSPA) MMSEA Section 111 reporting. He uses these skills in disputes regarding the valuation of pharmaceuticals and drug costs and in the review and audit of pain management and opioid prescribers under state Standards and the Controlled Substances Act. He consults to venture capital and private equity firms on mHealth, Cloud Computing in Healthcare, and Software as a Service. He advises ERISA self-insured employers on cost of care and regulations. Arrigo was recently retained by the U.S. Department of Justice (DOJ) regarding a significant false claims act investigation. He has provided opinions on over $1 billion in health care claims and due diligence on over $8 billion in healthcare mergers and acquisitions. Education: UC Irvine - Economics and Computer Science, University of Southern California - Business, studies at Stanford Medical School - Biomedical Informatics, studies at Harvard Medical School - Bioethics. Trained in over 10 medical specialties in medical billing and coding. Trained by U.S. Patent and Trademark Office (USPTO) and PTAB Judges on patent statutes, rules and case law (as a non-attorney to better advise clients on Technical and Damages aspects of patent construction and claims). Mr. Arrigo has been interviewed quoted in the Wall Street Journal, New York Times, and National Public Radio, Fortune, KNX 1070 Radio, Kaiser Health News, NBC Television News, The Capitol Forum and other media outlets. See https://www.noworldborders.com/news/ and https://www.noworldborders.com/clients/ for more about the company.

Leave a Reply