AHA Coding Clinic® for HCPCS - 2022 Quarter 2; In This Issue
Coding tips from the NCCI Policy Manual: Chapter X — CPT Codes 80000-89999
A physician ordered both a drug screen and a urinalysis. There is an NCCI edit that prevents reporting CPT code 81001 with code 80307 . What modifier can be appended so that both codes can be reported, Modifier 59, Distinct Procedural Service , or XU, Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service ? ...
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Article Overview
This article summarizes guidance from the NCCI Policy Manual for pathology and laboratory services within the CPT 80000-89999 range. It is aimed at facility coders, compliance staff, and revenue cycle professionals who need a public overview of common reporting topics, including panels, drug testing, hematology/coagulation, bone and marrow procedures, prostate pathology, and the role of related NCCI edits and modifiers. The article also references CMS and Medicaid NCCI resources and discusses general principles for accurate facility reporting.
Why This Topic Matters
Pathology and laboratory coding often involves overlapping tests, panel structures, and related procedures that can affect claim accuracy and compliance. Understanding the scope of this article helps readers identify whether it addresses the specific coding topics, code sets, and policy references they need to review.
Article Sections
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General guidelines and information
Introduces the chapter’s scope and summarizes broad principles for facility reporting of pathology and laboratory services. It also references the relevant CMS and Medicaid policy resources.
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Organ or disease-oriented panels
Covers panel-based laboratory reporting concepts and the interaction between panel codes and component tests. It also mentions related NCCI edits and commonly referenced modifiers.
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Evocative/suppression testing
Addresses laboratory testing that involves pharmaceutical administration and related reporting considerations. This section also notes associated HCPCS Level II and CPT ranges.
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Drug testing
Reviews presumptive and definitive drug testing topics, including related HCPCS Level II code references and specimen validity testing. It also identifies a distinct definitive drug testing code.
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Hematology and coagulation
Discusses blood counts, manual smear examination, and bone or marrow biopsy and aspiration topics. It also covers related surgical pathology and bone marrow interpretation reporting.
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Prostate biopsy
Summarizes pathology reporting for prostate needle biopsy specimens. This section focuses on the surgical pathology aspect of the procedure.
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Questions and answers
Provides an applied question-and-answer format illustrating the guidance discussed earlier in the article. It focuses on common reporting scenarios involving laboratory services and related edits.
What You Will Learn
- How the NCCI Policy Manual frames pathology and laboratory reporting for facility claims
- Which broad laboratory service categories are emphasized in the chapter
- How panels, drug testing, hematology, and biopsy-related services are addressed at a high level
- What related policy resources and NCCI references are cited
- Which general types of modifiers and edits are discussed in connection with laboratory reporting
Who Should Read This
- Facility coders
- Hospital outpatient coding staff
- Compliance professionals
- Revenue cycle teams
- Medical auditors
- Physician billing and coding staff
Codes Discussed
Code Ranges Discussed
Modifiers Discussed
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