Pathology/Lab Coding Alert

Question: If a physician requests a review of his diagnosis based on patient history, clinical findings and lab test results, can we bill a consult? What code should we use?

Texas Subscriber

Answer: Yes, you can bill a consultation under certain circumstances, and the code choice depends on the extent of the review.

Because the physician requests the consultation based on patient history and clinical findings in the medical record as well as lab test results, you should code the service as 80502 (Clinical pathology consultation; comprehensive, for a complex diagnostic problem, with review of patient's history and medical records). This service is more comprehensive than a consultation based on reviewing only lab test results (80500, ... limited, without review of patient's history and medical records).

Consult prerequisites: To bill clinical pathology consultations, you must meet certain requirements, as follows:

1. The patient's attending physician must request the consultation, and standing orders do not suffice

2. The consultation must relate to a test result that lies outside the clinically significant normal or expected range in view of the condition of the patient

3. The consulting physician must document results in a written report included in the patient's medical record

4. The service must involve the exercise of medical judgment by the consultant physician.