Pathology and Laboratory

Pathology and Laboratory CPT codes are categorized into different levels, each serving a specific purpose:

• Tier 1 (80000-89398): These codes cover general laboratory tests, such as chemistry, hematology, and immunology.
• Tier 2 (89399-89999): Tier 2 codes include Pathology and Laboratory procedures that don't fall under the Tier 1 categories. This level is typically used for specialized or less common tests.
• Tier 3 (90000-99000): These codes are designated for Pathology and Laboratory services related to clinical diagnostic testing. They encompass molecular diagnostics, cytogenetics, and more.

To ensure proper coding and billing, healthcare providers must adhere to specific key components and documentation requirements when using Pathology and Laboratory CPT codes. These elements include:

• Test Description: Accurate and detailed descriptions of the tests performed are essential for proper coding.
• CPT Code Selection: Choosing the correct CPT code that best matches the test or procedure conducted is vital to avoid coding errors.
• Modifiers: Using modifiers when necessary to provide additional information about the service, such as whether it was bilateral or a repeat procedure.
• Medical Necessity: Ensuring that the tests ordered are medically necessary and supported by clinical documentation.
• Laboratory Reports: Retaining complete and accurate laboratory reports is critical for documentation.
• Compliance: Staying up to date with coding guidelines, regulations, and compliance standards to prevent coding errors and reduce audit risk.

Pathology and Laboratory CPT codes encompass a wide range of services, including but not limited to:

• Blood tests
• Urinalysis
• Tissue examinations
• Microbiology testing
• Cytology and pathology consultations
• Immunology assays
• Toxicology screens
• Molecular diagnostics
• Genetic testing
• Histocompatibility testing
• And much more