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A clinical pathology consultation, represented by CPT® Code 80504, is a specialized service provided by a pathologist aimed at addressing moderately complex clinical problems. This consultation involves a thorough review of the patient's history and medical records, alongside a moderate level of medical decision-making. The pathologist is tasked with interpreting one or more pathology or laboratory test results, as well as providing additional medical judgment on relevant clinical or diagnostic information. Such consultations are typically requested by a physician or another qualified healthcare professional when there is a need for further evaluation of test results, radiology findings, operative notes, or other clinical data that may fall outside expected parameters or require deeper medical interpretation. The pathologist's role is crucial in these scenarios, as they synthesize the information available to offer insights that can guide further patient management. At the conclusion of the consultation, the pathologist generates a written report detailing their findings and recommendations. The time spent on this consultation ranges from 21 to 40 minutes, which is a key factor in determining the appropriate coding for the service. This structured approach ensures that the complexities of the patient's condition are adequately addressed, facilitating informed decision-making in their ongoing care.
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The clinical pathology consultation represented by CPT® Code 80504 is indicated for situations involving moderately complex clinical problems. These may include, but are not limited to, the following:
The procedure for a clinical pathology consultation under CPT® Code 80504 involves several key steps that ensure a comprehensive evaluation of the patient's condition:
After the clinical pathology consultation is completed, the pathologist's written report is delivered to the requesting physician or healthcare professional. This report includes the findings from the consultation and any recommendations for further action or management of the patient's condition. The total time spent on the consultation, which ranges from 21 to 40 minutes, is an important factor for coding purposes. If additional time is required beyond the initial consultation, CPT® Code 80506 should be reported for each additional 30 minutes spent on prolonged consultation services. It is essential for the requesting physician to review the report thoroughly to integrate the pathologist's insights into the patient's ongoing care plan.
| Short Descr | PATH CLIN CONSLTJ MOD 21-40 | Medium Descr | PATHOLOGY CLINICAL CONSULTATION MOD MDM 21-40MIN | Long Descr | Pathology clinical consultation; for a moderately complex clinical problem, with review of patient's history and medical records and moderate level of medical decision making When using time for code selection, 21-40 minutes of total time is spent on the date of the consultation. | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | GC | This service has been performed in part by a resident under the direction of a teaching physician | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | AJ | Clinical social worker | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | 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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| 2022-01-01 | Added | Code added |
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