Question

Coding for Laboratory Services

Laboratory testing is one of the most common types of ancillary services that providers will request to be performed on a patient. There are many reasons why laboratory testing may be completed. Consider a time when you or a loved one had lab testing. Perhaps use these tests as your example when sharing your code selections during this discussion.

Apply your knowledge of what you have learned in this CPT section.

Include the following aspects in the discussion:

• Select and describe two coding examples of Laboratory services.
• Interpret why a physician would order these tests for a patient.
• Discuss whether your code selections may require a modifier and if so, include this information. Do not choose the same codes as your peers

Answer 1

Ans) Common Procedural Technology (CPT codes) are numbers assigned to every task and service a medical practitioner may provide to a patient including medical, surgical, and diagnostic services. They are used by insurers to determine the amount of reimbursement that a practitioner will receive by an insurer for that service. Since everyone uses the same codes to mean the same thing, they ensure uniformity.

- CPT codes serve both tracking and billing purposes and are similar to, but not exactly the same as, codes tied to the Healthcare Common Procedure Coding System (HCPCS). If you use Medicare, you'll see HCPCS codes in your paperwork instead of CPT codes.

- A CPT code is a five-digit numeric code with no decimal marks, although some have four numbers and one letter. Codes are uniquely assigned to different actions. While some may be used from time to time (or not at all by certain practitioners), others are used frequently (e.g., 99213 or 99214 for general check-ups).

- CPT codes are developed, maintained and copyrighted by the AMA (American Medical Association). As the practice of health care changes, new codes are developed for new services, current codes may be revised, and old, unused codes discarded. Thousands of codes are in use and updated annually.

- Uniformity in understanding what the service is and the amount different practitioners get reimbursed will not necessarily be the same. That is determined by the contracts between individual providers and insurers.

- For example, Doctor A may perform a physical check-up (99396) and be reimbursed $100 by your insurance company. If you went to Doctor B, his reimbursement by your insurance company for that same checkup/CPT code might only be $90.

- There are several categories of CPT codes, including:

Category I: Devices and drugs, including vaccines
Category II: Performance measures and quality of care
Category III: Services and procedures using emerging technology
PLA codes, which are alpha-numeric CPT codes used for lab testing

Examples:

99214 may be used for an office visit
99397 may be used for a preventive exam if you are over 65
90658 indicates a flu shot
90716 may be used for chickenpox vaccine (varicella)
12002 may be used when a doctor stitches up a one-inch cut on your arm.