Pathology/Lab Coding Alert

Question: I’m trying to use the new clinical pathology consultation codes. Could you explain what is included in “time” if we want to code the pathologists’ work based on time?

Texas Subscriber

Answer: The codes you’re referring to are 80503-+80506 (Pathology clinical consultation …), which replace deleted codes 80500 and 80502 (Clinical pathology consultation …) in CPT^® 2022.

Codes 80503-80505 represent three increasing levels of medical decision making (MDM) complexity, but you may instead select the code based on ascending periods of time. The time periods are 5-20 minutes (80503), 21-40 minutes (80504), or 41-60 minutes (80505).

If the pathologist spends more than 60 minutes, you should report 80505 and +80506 (… prolonged service, each additional 30 minutes (List separately in addition to code for primary procedure)). Use +80506 for each additional 15 to 30 minutes documented beyond 60 minutes. If the additional time is less than 15 minutes, don’t use the add-on code.

What counts: CPT^® guidelines provide the following list of activities that the pathologist performs that count toward your time calculation:

• Review of medical history such as present complaint, signs and symptoms, and personal and family history
• Review and comparison of relevant diagnostic test results such as past and current lab, pathology, and imaging findings
• Review of relevant clinical findings
• Determining differential diagnosis
• Ordering or recommending additional or follow-up testing
• Communicating with and/or referring to other health care professionals
• Explaining consultation results to the ordering clinician or other qualified health care professional
• Documenting the clinical consultation report in the health record