Pathology/Lab Coding Alert

Question: Our hematopathologist often performs a chart review prior to a stem cell harvest (apheresis). For example, he may review medical necessity, current medications, allergies, labs, vitals and access catheter. What is the appropriate billing? Usually the hemato-pathologist and the patient do not meet face-to-face. In addition to the apheresis service, should we report an E/M code, or a consult code such as 80500 or 80502?

Arizona Subscriber

Answer: According to the CPT manual, A clinical pathology consultation is a service, including a written report, rendered by the pathologist in response to a request from an attending physician in relation to a test result(s) requiring additional medical interpretive judgment. The hematopathologists service that you describe appears not to meet several of these criteria. Unless the chart review involves a specific request from the attending physician about test results that require further interpretation and a written report by the hematopathologist, you should not report the clinical pathology consultation codes, 80500 or 80502.

The chart review service you describe also does not meet the criteria for most E/M services, including the E/M consultation codes (99241-99275), which require face-to-face time with the patient. Like the pathology consultation codes, the E/M consultation codes also require a request by the attending physician. If there is not an order on the patients chart for a consultation, these codes should not be reported.

If the hematopathologist does have face-to-face time with the patient, evaluating the patients history and current physical condition and appropriateness of the procedure, a suitable E/M code may be warranted.

A Correct Coding Initiative (CCI) edit bundles E/M codes 99231-99233 (subsequent hospital care) with 36520 (apheresis). This means that hematopathologist oversight of the patient during the procedure, including such services as monitoring plasma flow and fluid replacement, and being available to intervene in the event of complications, is included in the apheresis service.