In-OfficeLabTesting. Effective date: August 1, 2017
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1 Effective date: August 1, 2017 In-OfficeLabTesting The lab services below can be performed and reimbursed in an office setting. All other office-based lab services must be submitted through our contracted laboratory providers. CPT G0306 G0307 G0480 Description Complete CBC, automated (HgB, HCT, RBC, WBC, without platelet count) and automated WBC differential count Complete (CBC), automated (HgB, Hct, RBC, WBC; without platelet count) Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed. G0481 G0482 G0483 Q0111 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed. Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, drug class(es), including metabolite(s) if performed.) Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 22 or more drug class(es), including metabolite(s) if performed. Wet mounts, including preparations of vaginal, cervical or skin specimens PS_INFOLAB_
2 80048 Basic Metabolic panel Electrolyte Panel (must include Carbon Dioxide, Chloride, Potassium and Sodium) Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg, immunoassay) capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg, immunoassay) read by instrument-assisted direct optical observation (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service. Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures by instrument chemistry analyzers (eg, utilizing immunoassay, eg IA, EIA, ELISA, EMIT, FPIA, KIMS, RIA) chromatography, (eg. GC, HPLC) and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC- MS/MS, ML- MS/MS, LDTD, MALDI, TOF) including sample validation when performed, per date of service. Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein specific gravity, urobilinogen, any number of these constituents; automated, with microscopyurinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein specific gravity, urobilinogen, any number of these constituents; automated, with microscopy UA dip stick/tablet reagent; w/o micro non-auto Automated, urine analysis without microscopy Urinalysis; qualitative or semi-quantitative, except immunoassays Urine pregnancy test, by visual color comparison methods Albumin; urine, microalbumin, quantitative Albumin; urine, microalbumin, semiquantitative (eg, reagent strip assay) Bilirubin; Total Blood, occult, by peroxidase activity (eg, guaiac); feces, 1-3 simultaneous Blood, occult, by peroxidase activity, single specimen Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, Cholesterol, serum or whole blood, total Creatinine, Blood Creatinine; other source Glucose; quantitative, blood (except reagent strip) Glucose; blood, reagent strip
3 82950 Post glucose dose (includes glucose) Glucose; tolerance test (GTT), 3 specimens (includes glucose) Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home HGA1c Hemoglobin; glycosylated (A1C) by device cleared by FDA for home use Lead ph, body fluid, except blood Phenylalanine (PKU), blood Protein, total, except by refractometry; urine Urea Nitrogen, Quantitative Quantitative HCG Gonadotropin, chorionic (HCG); qualitative Blood count; automated differential wbc count Blood count; manual differential WBC count (includes RBC morphology and platelet estimation) Blood count; spun micro-hematocrit Blood count; other than spun hematocrit Blood count; hemaglobin Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) Blood count; manual cell count (erythrocyte leukocyte or platelet) each Blood count; platelet automated Prothrombin time Sedimentation rate, erythrocyte; non-automated Thromboplastin time, partial (PTT); plasma or whole blood C-reactive protein: Heterophile antibodies; screening Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step Particle agglutination; screen, each antibody Skin test; tuberculosis, intradermal H Pylori Antibody; HIC Antibody; HIC HIV-1/HIV-2 SINGLE RESULT Antibody; influenza virus
4 86756 Antibody; respiratory syncytial virus Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate Culture, presumptive, pathogenic organisms, screening only Culture, bacterial; with isolation and presumptive identification of isolates, urine DTM Culture Culture, chlamydia, any source Ova and parasites, direct smears, concentration and identification KOH Prep Smear, primary source with interpretation, Gram or Giemsa stain for bacteria, fungi, or cell types Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps) Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; Chlamydia trachomatis HIV-1 AG W/HIV-1 & HIV-2 AB Antibody; HIV-1 and HIV-2, single result HIV-2 AG IA Rotavirus Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; Influenza, A or B, each Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; Streptococcus, group A Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, quantification Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, reverse transcription and amplified probe technique, each type or subtype Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, first 2 types or sub-types
5 Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, multiplex reverse transcription and amplified probe technique, each additional influenza virus type or sub-type beyond 2 (List separately in addition to code for primary procedure) Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, direct probe technique Streptococcus, group B Clostridium difficile toxin A Influenza respiratory syncytial virus Trichomonas vaginalis Chlamydia trachomatis Infectious agent detection by immunoassay with direct optical observation; Streptococcus, group A Infectious agent enzymatic activity other than virus (eg., sialidase activity in vaginal fluid) Tissue culture for non-neoplastic disorders; lymphocyte Tissue culture for non-neoplastic disorders; skin or other solid tissue biopsy Tissue culture for non-neoplastic disorders; amniotic fluid or chorionic villus cells Tissue culture for neoplastic disorders; bone marrow, blood cells Tissue culture for neoplastic disorders; solid tumor Cryopreservation, freezing and storage of cells, each cell line Thawing and expansion of frozen cells, each aliquot Chromosome analysis for breakage syndromes; baseline Sister Chromatid Exchange (SCE), cells
6 Chromosome analysis for breakage syndromes; baseline breakage, score cells, count 20 cells, 2 karyotypes (eg, for ataxia telangiectasia, Fanconi anemia, fragile X) Chromosome analysis for breakage syndromes; score 100 cells, clastogen stress (eg, diepoxybutane, mitomycin C, ionizing radiation, UV radiation) Chromosome analysis; count 5 cells, 1 karyotype, with banding Chromosome analysis; count cells, 2 karyotypes, with banding Chromosome analysis; count 45 cells for mosaicism, 2 karyotypes, with banding Chromosome analysis; analyze cells Chromosome analysis, amniotic fluid or chorionic villus, count 15 cells, 1 karyotype, with banding Chromosome analysis, in situ for amniotic fluid cells, count cells from 6-12 colonies, 1 karyotype, with banding Molecular cytogenetics; DNA probe, each (eg, FISH) Molecular cytogenetics; chromosomal in situ hybridization, analyze 3-5 cells (eg, for derivatives and markers) Molecular cytogenetics; chromosomal in situ hybridization, analyze cells (eg, for microdeletions) Molecular cytogenetics; interphase in situ hybridization, analyze cells Molecular cytogenetics; interphase in situ hybridization, analyze cells Chromosome analysis; additional karyotypes, each study Chromosome analysis; additional specialized banding technique (eg, NOR, C- banding) Chromosome analysis; additional cells counted, each study Chromosome analysis; additional high resolution study Cytogenetics and molecular cytogenetics, interpretation and report Bilirubin
7 89051 Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count Nasal smear for eosinophils Note: All other laboratory services must be directed to our contracted laboratory providers. Specialty lab services will continue to be submitted through Doctors Laboratory, Genzyme Genetics, Finan Dermatopathology, Atlanta Dermatology and Pathology and Chatham County Board of Health Lab.
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