Chapter 18 - LABORATORY - with Answers&Rationale

Chapter 18 – LABORATORY 1. Tests in the Chemistry section of CPT® are what types of tests unless specified otherwise? Answer: Quantitative Rationale: The codes in the Chemistry section () identify how much of a substance is present in the specimen. According to the guidelines, “The examination is quantitative unless specified.” 2. What modifier must always be applied to Medicare claims for tests performed in a site with a CLIA Waived certificate? Answers: QW Rationale: Medicare requires that the QW modifier be applied for all claims for payment of test performed in a site with a CLIA waived certificate. If the location does not have a certificate, the service should not only not be billed, it should not be performed. Modifier QW is found in the HCPCS Level II codebook. 3. What does “in vivo” mean? Answer: in the living body Rationale: None – Self explanatory 4. What is the code for gross and microscopic examination (surgical pathology) of breast tissue from a simple mastectomy? Answer: 88307 Rationale: In the CPT® Index, look for Pathology and Laboratory/Surgical Pathology/Gross and Micro Exam. Review these codes to determine the correct code. There are a number of codes for examination of breast tissue. The coder must be careful to choose the code describing the exact specimen received. Simple mastectomy is listed under 88307. 5. In what section of the Pathology chapter of CPT® will a coder find codes for a FISH test? Answer: Cytopathology Rationale: The fluorescent in situ hybridization or FISH test is a cytopathology test. You are directed to this by looking at FISH in the CPT® Index. FISH directs you to See Fluorescent In Situ Hybridization. 6. The suffix -ology means Answer: Study of Rationale: -ology means the study of. 7. What modifier identifies the professional component of a service? Answer: 26 Rationale: Modifier 26 identifies the Professional component. Modifier TC identifies the technical component. There is no modifier PC. The HCPCS Level I modifiers are listed in the CPT® codebook in Appendix A and the HCPCS Level II modifiers are listed in the HCPCS codebook. 8. A patient presents with worries she is at risk for cancer. She asks for tests to verify whether she has cancer. The test comes back normal. What type of service is this considered? Answer: Screening services Rationale: Services performed when there are no symptoms and returning normal results are considered screening services. 9. HCPCS Level II codes specifically for Pathology and Laboratory services all start with what letter? Answer: P Rationale: In the HCPCS codebook, P2028-P9615 report Pathology and Laboratory Services including chemistry, toxicology and microbiology tests, screening Pap procedures and various blood products