Pathology/Lab Coding Alert

Get time-specific with new codes.

Pathologists will lose two codes in CPT^® 2022 for pathology clinical consultation, but gain four new codes in their place.

Here’s a preview of the pathology clinical consultation code update and what it could mean for your practice next year.

Remember: “Keeping abreast of code changes can be important to your practice’s bottom line,” says Melanie Witt, RN, MA, an independent coding consultant from Guadalupita, New Mexico.

Check Out the Codes

You won’t have the following two codes next year, because CPT^® 2022 deletes them:

• 80500 (Clinical pathology consultation; limited, without review of patient’s history and medical records)
• 80502 (… comprehensive, for a complex diagnostic problem, with review of patient’s history and medical records)

In their place, you’ll have the following new codes, effective January 1, 2022:

• 80503 (Pathology clinical consultation; for a clinical problem, with limited review of patient’s history and medical records and straightforward medical decision making. When using time for code selection, 5-20 minutes of total time is spent on the date of the consultation)
• 80504 (… for a moderately complex clinical problem, with review of patient’s history and medical records and moderate level of medical decision making. When using time for code selection, 21-40 minutes of total time is spent on the date of the consultation)
• 80505 (… for a highly complex clinical problem, with comprehensive review of patient’s history and medical records and high level of medical decision making. When using time for code selection, 41-60 minutes of total time is spent on the date of the consultation)
• +80506 (… prolonged service, each additional 30 minutes (List separately in addition to code for primary procedure))

“The four new codes differentiate pathology clinical consultation in more detail than the two deleted codes, including more specific description of the levels of physician work, as well as introducing the element of time for code selection,” says R.M. Stainton Jr., MD, president of Doctors Anatomic Pathology Services in Jonesboro, Ark.

E/M: These new codes parallel recent CPT^® changes to Evaluation and Management (E/M) codes that other specialty physicians use to report patient visits. Like revised E/M codes, these new pathology clinical consultation codes focus on the complexity of the clinical problem and level of medical decision making, which would require documentation to support the chosen code.

Time: Alternately, these new codes allow the pathologist to use time for code selection — an option that wasn’t available with deleted codes 80500 and 80502. The add-on code, +80506, allows you to report time documented beyond 60 minutes when you’re reporting 80505.

Know When to Use the Codes

To use codes 80503-+80506, you need to meet certain criteria. Similar to codes 80500-80502 before them, you should turn to the new codes when you have documentation of the following facts:

• A physician or qualified healthcare professional requested the pathology clinical consultation
• The request is related to a laboratory finding and relevant clinical information that requires extra medical judgement beyond a simple interpretation of results.
• The pathologist renders the medical judgement and reports back to the requesting clinician.

More to follow: Several outstanding issues beyond the scope of the code definitions remain for clarification, such as who can report the codes, and what sort of laboratory/pathology findings qualify for the consultation. Also, you’ll need to learn how use new codes 80503-+80506 in relation to existing, similar codes, such as G0452 (Molecular pathology procedure; physician interpretation and report) or 88291 (Cytogenetics and molecular cytogenetics, interpretation and report). Look to future issues of Pathology/Laboratory Coding Alert for a deeper dive on these questions.