Pathology/Lab Coding Alert

The primary revisions to the CPT Codes 2000 pathology and laboratory codes are contained in the organ- or disease-oriented panels (80048-80090). The alterations involve dropping and adding some entire panels, as well as changing the code number for some panels that have added or deleted component tests. Please note that the Health Care Financing Administration (HCFA) has issued special instructions that the new panel codes should not be reported until April 1, 2000; the existing CPT 1999 panel codes should be used until that time.

Elsewhere in the pathology codes, two tests have been added and one deleted. Some minor grammatical and terminology changes have been made in a few other codes. There also is a new modifier -91 that will affect reporting of repeat laboratory tests. All of these additional changes will be implemented Jan. 1, 2000.

In the panel codes, two thyroid panels (80091, thyroid panel, and 80092, with thyroid stimulating hormone [THS]) were deleted in CPT 2000 with the instruction that specific component tests be reported separately if they are carried out. On the other hand, an all-new renal function panel (80069) was added.

Several other panel codes were added that arent actually new but represent a change in code number with a modification to the tests included in the panel. For example, the new basic metabolic panel(80048) is similar to one that was deleted (80049) except that a test has been added for calcium (82310). Similarly, the new comprehensive metabolic panel (80053) is similar to the old one that has been deleted (80054) except that a test has been added for transferase, alanine amino(ALT) (SGOT) (84460). Also new is the direction not to use the metabolic panels (80048 and 80053) together.

The hepatic function panelcode (80076) is new, changed from the old panel (80058) because the test for protein, total (84155) was added. The acute hepatitis panel code (80074) also is new, having been changed from the old panel (80059) to reflect revisions in the covered tests. The new panel includes the test for hepatitis A antibody (HAAb); IgM antibody (86709) instead of hepatitis A antibody (HAAb); IgG and IgM (86708). It also includes the test for hepatitis B core antibody (HBcAb); IgM antibody(86705) instead of hepatitis B surface antibody (HBsAb) (86706).

Other than the panel codes, two other tests have been added for pathology in CPT 2000. These include 82120 (amines, vaginal fluid, qualitative) in the chemistry codes, and 87338 (helicobacter pylori, stool) in the microbiology codes. Code 86588 (streptococcus screen, direct) was deleted and should now be reported using existing codes 86403, 87081, 87430, or 87880, based on the screening method involved. Note that the special stains (88311-88314) now must be used as add-on codes, which is consistent with the direction contained in these codes to list separately in addition to code for surgical pathology.

A new modifier -91 (repeat clinical diagnostic laboratory test) appears in CPT 2000. This modifier should be appended to a code for a laboratory test that is repeated on the same day for the same patient because of the need for subsequent results. The modifier is not to be used for a test that is repeated to confirm initial results; due to testing problems with specimens or equipment; or for any other reason when a normal, one-time, reportable result is all that is required. Also, modifier -91 should not be used to report a repeated laboratory test that is a component of a test series that was done earlier, such as evocative/suppression tests.

Changes to Pap Guidelines

The CPT 2000 clears up what has been a source of confusion in the Pap guidelines. The automated screening codes (88147-88148) were inadvertently left out of the parenthetical notes for the add-on codes, according to the May 1999 CPT Assistant. This led coders to believe that physician interpretation, 88141, and hormone evaluation, 88155, could not be reported with automated Pap screenings.

The omission is corrected in the new CPT 2000. The new codes also return the missing explanation, under physician supervision, to code 88148. With no other changes, and a better understanding of the code families, levels of service and add-on codes, the Pap guidelines should be a little easier to use this year.

Source for Update: Susan Callaway-Stradley,
CPC, CCS-P, an independent coding consultant in
North Augusta, S.C.