SAMPLE. Laboratory Services. An essential coding, billing, and reimbursement resource for laboratory and pathology services ICD-10

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1 Coding and Payment Guide Laboratory Services An essential coding, billing, and reimbursement resource for laboratory and pathology services 2017 ICD-10 A full suite of resources including the latest code set, mapping products, and expert training to help you make a smooth transition.

2 Introduction Optum360 is pleased to present the 2016 Laboratory Cross Coder. Fully comprehensive, Laboratory Cross Coder links most CPT laboratory codes to corresponding ICD-10-CM diagnosis and HCPCS Level II codes. Optum360 believes that professional coders working in laboratories, physician s offices, clinical outpatient areas, hospitals, as well as payer settings will embrace this reference. Laboratory Cross Coder is based on the Pathology and Laboratory section of the Current Procedural Terminology (CPT). Up-to-date CPT laboratory codes link to the following related medical coding systems: International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Healthcare Common Procedural Coding System (HCPCS) Level II All coding relationships in Laboratory Cross Coder spring from CPT s pathology and laboratory codes and the term CPT-driven is sometimes heard. But it is perhaps more appropriate to think of this reference book as data driven. A team of clinical and coding experts launched Laboratory Cross Coder by first reviewing data drawn from the Optum360 information base of nationwide medical claims. Pertinent laboratory-related coding relationships were drawn from the data stream and processed for coding errors and other anomalies. From this early cut of data emerged a general clinical picture of each laboratory code, but data analysis for Laboratory Cross Coder had hardly begun. Laboratory Cross Coder features codes that require accompanying etiologies or manifestations (e.g., Code first underlying disease ). For a discussion on secondary diagnosis codes, see the ICD-10-CM section later in this Introduction. However, certain laboratory procedures are performed for almost any diagnosis and are simply too numerous to list. In such instances, the associated diagnoses do not appear in Laboratory Cross Coder. Some CPT codes are omitted from the listing because consistent and reliable cross-links are almost impossible to establish. Unlisted procedure codes are an obvious example. Certain types of add-on codes are also treated somewhat differently in Laboratory Cross Coder. These codes are discussed in greater detail under the CPT Codes section later in this Introduction. As a data-driven coding reference, Laboratory Cross Coder presents most likely scenarios as derived from clinical information sources. However, Laboratory Cross Coder is not a substitute for ICD-10-CM or any other medical coding reference and users are urged to regularly consult all available sources. The absence of any specific code does not necessarily indicate that its association to the base procedure code is inappropriate. Assuming all rules of laboratory coding are followed, excepted diagnosis codes may prove appropriate to a specific code scenario. Laboratory Cross Coder does not include coding rules or guidelines. Once again, the user is urged to consult the original coding reference (e.g., CPT, ICD-10-CM, HCPCS Level II, etc.) or one of several reputable medical coding instruction manuals. Format An understanding of the Laboratory Cross Coder format allows users to easily navigate its content. Information within the main section ties to the CPT book and the codes are presented in the same numeric order as the pathology and laboratory section. Sections Laboratory Cross Coder provides linked information to the CPT code range to The codes are divided into the same sections as the Pathology and Laboratory section of the CPT book. Codes and Code Ranges The data within each CPT code set of Laboratory Cross Coder is presented as follows: CPT code or code range CPT codes and descriptions ICD-10-CM diagnostic codes and descriptions HCPCS Level II codes and descriptions For example: MCOLN1 (mucolipin 1) (eg, Mucolipidosis, type IV) gene analysis, common variants (eg, IVS3-2A>G, del6.4kb) ICD-10-CM Diagnostic E75.11 Mucolipidosis IV Z13.71 Encounter for nonprocreative screening for genetic disease carrier status Z13.79 Encounter for other screening for genetic and chromosomal anomalies Z31.5 Encounter for genetic counseling Each CPT code or code range is followed by its specific ICD-10-CM and HCPCS Level II links. Laboratory Cross Coder presents full descriptions for all CPT codes and their links. Keep in mind that ICD-10-CM codes are hierarchical and their full descriptions are by nature incomplete. The Optum360 database and Laboratory Cross Coder feature complete descriptions for ICD-10-CM codes. For example, the official description for E is a seventh-digit subclassification for use with category E10 and appears as follows in ICD-10-CM: E10 Type 1 diabetes mellitus E10.6 Type 1 diabetes mellitus with other specified complications E10.64 Type 1 diabetes mellitus with hypoglycemia E Type 1 diabetes mellitus with hypoglycemia with coma Laboratory Cross Coder presents the description of code E as follows: E Type 1 diabetes mellitus with hypoglycemia with coma Complete descriptions are presented throughout this book. National Coverage Decisions Your Laboratory Cross Coder also indicates when a service is subject to a National Coverage Decision (NCD) by placing NCD after the code. An NCD for a diagnostic laboratory test is a national policy statement granting, limiting, or excluding Medicare coverage for that test. An NCD will indicate Medicare policy regarding the circumstances under which the test will be considered reasonable and necessary. This is important because Medicare 2016 American Medical Association. All Rights Reserved. i

3 80061 I50.40 I50.41 I50.42 I50.43 I50.9 I51.9 I52 I61.0 I61.1 I61.2 I61.3 I61.4 I61.5 I61.6 I61.8 I61.9 I63.00 I I I I63.02 I I I I63.09 I63.10 I I I I63.12 I I I I63.19 I63.20 I I I I63.22 I I I I63.29 I63.30 I I I I I I I I Unspecified combined systolic (congestive) and diastolic (congestive) heart failure 2 Acute combined systolic (congestive) and diastolic (congestive) heart failure Chronic combined systolic (congestive) and diastolic (congestive) heart failure Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure Heart failure, unspecified 2 Heart disease, unspecified 2 Other heart disorders in diseases classified elsewhere E Nontraumatic intracerebral hemorrhage in hemisphere, subcortical Nontraumatic intracerebral hemorrhage in hemisphere, cortical Nontraumatic intracerebral hemorrhage in hemisphere, unspecified 2 Nontraumatic intracerebral hemorrhage in brain stem Nontraumatic intracerebral hemorrhage in cerebellum Nontraumatic intracerebral hemorrhage, intraventricular Nontraumatic intracerebral hemorrhage, multiple localized Other nontraumatic intracerebral hemorrhage Nontraumatic intracerebral hemorrhage, unspecified 2 Cerebral infarction due to thrombosis of unspecified pre 2 Cerebral infarction due to thrombosis of right vertebral Cerebral infarction due to thrombosis of left vertebral Cerebral infarction due to thrombosis of unspecified vertebral Cerebral infarction due to thrombosis of basilar Cerebral infarction due to thrombosis of right carotid Cerebral infarction due to thrombosis of left carotid Cerebral infarction due to thrombosis of unspecified carotid Cerebral infarction due to thrombosis of other pre Cerebral infarction due to embolism of unspecified pre 2 Cerebral infarction due to embolism of right vertebral Cerebral infarction due to embolism of left vertebral Cerebral infarction due to embolism of unspecified vertebral Cerebral infarction due to embolism of basilar Cerebral infarction due to embolism of right carotid Cerebral infarction due to embolism of left carotid Cerebral infarction due to embolism of unspecified carotid Cerebral infarction due to embolism of other pre precerebral 2 Cerebral infarction due to unspecified occlusion or stenosis of right vertebral Cerebral infarction due to unspecified occlusion or stenosis of left vertebral vertebral 2 Cerebral infarction due to unspecified occlusion or stenosis of basilar Cerebral infarction due to unspecified occlusion or stenosis of right carotid Cerebral infarction due to unspecified occlusion or stenosis of left carotid carotid 2 Cerebral infarction due to unspecified occlusion or stenosis of other precerebral 2 Cerebral infarction due to thrombosis of unspecified 2 Cerebral infarction due to thrombosis of right middle Cerebral infarction due to thrombosis of left middle Cerebral infarction due to thrombosis of unspecified middle cerebral Cerebral infarction due to thrombosis of right anterior Cerebral infarction due to thrombosis of left anterior Cerebral infarction due to thrombosis of unspecified anterior cerebral Cerebral infarction due to thrombosis of right posterior Cerebral infarction due to thrombosis of left posterior I Cerebral infarction due to thrombosis of unspecified posterior cerebral I Cerebral infarction due to thrombosis of right cerebellar I Cerebral infarction due to thrombosis of left cerebellar I Cerebral infarction due to thrombosis of unspecified cerebellar I63.39 Cerebral infarction due to thrombosis of other I63.40 Cerebral infarction due to embolism of unspecified 2 I Cerebral infarction due to embolism of right middle I Cerebral infarction due to embolism of left middle I Cerebral infarction due to embolism of unspecified middle 2 I Cerebral infarction due to embolism of right anterior I Cerebral infarction due to embolism of left anterior I Cerebral infarction due to embolism of unspecified anterior cerebral I Cerebral infarction due to embolism of right posterior I Cerebral infarction due to embolism of left posterior I Cerebral infarction due to embolism of unspecified posterior cerebral I Cerebral infarction due to embolism of right cerebellar I Cerebral infarction due to embolism of left cerebellar I Cerebral infarction due to embolism of unspecified cerebellar I63.49 Cerebral infarction due to embolism of other I I Cerebral infarction due to unspecified occlusion or stenosis of right middle I Cerebral infarction due to unspecified occlusion or stenosis of left middle I middle 2 I Cerebral infarction due to unspecified occlusion or stenosis of right anterior I Cerebral infarction due to unspecified occlusion or stenosis of left anterior I anterior 2 I Cerebral infarction due to unspecified occlusion or stenosis of right posterior I Cerebral infarction due to unspecified occlusion or stenosis of left posterior I posterior 2 I Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar I Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar I cerebellar I63.59 Cerebral infarction due to unspecified occlusion or stenosis of other cerebral I63.6 Cerebral infarction due to cerebral venous thrombosis, nonpyogenic I63.8 Other cerebral infarction I63.9 Cerebral infarction, unspecified 2 I65.01 Occlusion and stenosis of right vertebral I65.02 Occlusion and stenosis of left vertebral I65.03 Occlusion and stenosis of bilateral vertebral I65.09 Occlusion and stenosis of unspecified vertebral I65.1 Occlusion and stenosis of basilar I65.21 Occlusion and stenosis of right carotid I65.22 Occlusion and stenosis of left carotid I65.23 Occlusion and stenosis of bilateral carotid I65.29 Occlusion and stenosis of unspecified carotid I65.8 Occlusion and stenosis of other precerebral I65.9 Occlusion and stenosis of unspecified pre 2 I66.01 Occlusion and stenosis of right middle 17

4 I61.3 I61.4 I61.5 I61.6 I61.8 I61.9 I63.00 I I I I63.02 I I I I63.09 I63.10 I I I I63.12 I I I I63.19 I63.20 I I I I63.22 I I I I63.29 I63.50 I I I I I I I I I I I Nontraumatic intracerebral hemorrhage in brain stem Nontraumatic intracerebral hemorrhage in cerebellum Nontraumatic intracerebral hemorrhage, intraventricular Nontraumatic intracerebral hemorrhage, multiple localized Other nontraumatic intracerebral hemorrhage Nontraumatic intracerebral hemorrhage, unspecified 2 Cerebral infarction due to thrombosis of unspecified pre 2 Cerebral infarction due to thrombosis of right vertebral Cerebral infarction due to thrombosis of left vertebral Cerebral infarction due to thrombosis of unspecified vertebral Cerebral infarction due to thrombosis of basilar Cerebral infarction due to thrombosis of right carotid Cerebral infarction due to thrombosis of left carotid Cerebral infarction due to thrombosis of unspecified carotid Cerebral infarction due to thrombosis of other pre Cerebral infarction due to embolism of unspecified pre 2 Cerebral infarction due to embolism of right vertebral Cerebral infarction due to embolism of left vertebral Cerebral infarction due to embolism of unspecified vertebral Cerebral infarction due to embolism of basilar Cerebral infarction due to embolism of right carotid Cerebral infarction due to embolism of left carotid Cerebral infarction due to embolism of unspecified carotid Cerebral infarction due to embolism of other pre precerebral 2 Cerebral infarction due to unspecified occlusion or stenosis of right vertebral Cerebral infarction due to unspecified occlusion or stenosis of left vertebral vertebral 2 Cerebral infarction due to unspecified occlusion or stenosis of basilar Cerebral infarction due to unspecified occlusion or stenosis of right carotid Cerebral infarction due to unspecified occlusion or stenosis of left carotid carotid 2 Cerebral infarction due to unspecified occlusion or stenosis of other precerebral 2 2 Cerebral infarction due to unspecified occlusion or stenosis of right middle Cerebral infarction due to unspecified occlusion or stenosis of left middle middle 2 Cerebral infarction due to unspecified occlusion or stenosis of right anterior Cerebral infarction due to unspecified occlusion or stenosis of left anterior anterior 2 Cerebral infarction due to unspecified occlusion or stenosis of right posterior Cerebral infarction due to unspecified occlusion or stenosis of left posterior posterior 2 Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar I I63.59 I63.8 I63.9 I65.01 I65.02 I65.03 I65.09 I65.1 I65.21 I65.22 I65.23 I65.29 I65.8 I65.9 I66.01 I66.02 I66.03 I66.09 I66.11 I66.12 I66.13 I66.19 I66.21 I66.22 I66.23 I66.29 I66.3 I66.8 I66.9 I67.2 I67.81 I67.82 I I I67.89 I70.0 I70.1 I I I I I I I I I I I I I I I I cerebellar Cerebral infarction due to unspecified occlusion or stenosis of other cerebral Other cerebral infarction Cerebral infarction, unspecified 2 Occlusion and stenosis of right vertebral Occlusion and stenosis of left vertebral Occlusion and stenosis of bilateral vertebral Occlusion and stenosis of unspecified vertebral Occlusion and stenosis of basilar Occlusion and stenosis of right carotid Occlusion and stenosis of left carotid Occlusion and stenosis of bilateral carotid Occlusion and stenosis of unspecified carotid Occlusion and stenosis of other precerebral Occlusion and stenosis of unspecified pre 2 Occlusion and stenosis of right middle Occlusion and stenosis of left middle Occlusion and stenosis of bilateral middle cerebral Occlusion and stenosis of unspecified middle 2 Occlusion and stenosis of right anterior Occlusion and stenosis of left anterior Occlusion and stenosis of bilateral anterior cerebral Occlusion and stenosis of unspecified anterior 2 Occlusion and stenosis of right posterior Occlusion and stenosis of left posterior Occlusion and stenosis of bilateral posterior cerebral Occlusion and stenosis of unspecified posterior 2 Occlusion and stenosis of cerebellar Occlusion and stenosis of other cerebral Occlusion and stenosis of unspecified 2 Cerebral atherosclerosis Acute cerebrovascular insufficiency Cerebral ischemia Reversible cerebrovascular vasoconstriction syndrome Other cerebrovascular vasospasm and vasoconstriction Other cerebrovascular disease Atherosclerosis of aorta Atherosclerosis of renal Unspecified atherosclerosis of native of extremities, right leg 2 Unspecified atherosclerosis of native of extremities, left leg 2 Unspecified atherosclerosis of native of extremities, bilateral legs 2 Unspecified atherosclerosis of native of extremities, other Unspecified atherosclerosis of native of extremities, unspecified Atherosclerosis of native of extremities with intermittent claudication, right leg Atherosclerosis of native of extremities with intermittent claudication, left leg Atherosclerosis of native of extremities with intermittent claudication, bilateral legs Atherosclerosis of native of extremities with intermittent claudication, other extremity Atherosclerosis of native of extremities with intermittent claudication, unspecified Atherosclerosis of native of extremities with rest pain, right leg Atherosclerosis of native of extremities with rest pain, left leg Atherosclerosis of native of extremities with rest pain, bilateral legs Atherosclerosis of native of extremities with rest pain, other extremity Atherosclerosis of native of extremities with rest pain, unspecified Atherosclerosis of native of right leg with ulceration of thigh 203

5 86000 C84.73 C84.74 C84.75 C84.76 C84.77 C84.78 C84.79 C84.90 C84.91 C84.92 C84.93 C84.94 C84.95 C84.96 C84.97 C84.98 C84.99 C84.A0 C84.A1 C84.A2 C84.A3 C84.A4 C84.A5 C84.A6 C84.A7 C84.A8 C84.A9 C84.Z0 C84.Z1 C84.Z2 C84.Z3 C84.Z4 C84.Z5 C84.Z6 C84.Z7 C84.Z8 C84.Z9 C85.10 C85.11 C85.12 C85.13 C85.14 C85.15 C85.16 C85.17 C85.18 C85.19 C85.20 C85.21 C85.22 Anaplastic large cell lymphoma, ALK-negative, intra-abdominal lymph nodes Anaplastic large cell lymphoma, ALK-negative, lymph nodes of axilla and upper limb Anaplastic large cell lymphoma, ALK-negative, lymph nodes of inguinal region and lower limb Anaplastic large cell lymphoma, ALK-negative, intrapelvic lymph nodes Anaplastic large cell lymphoma, ALK-negative, spleen Anaplastic large cell lymphoma, ALK-negative, lymph nodes of multiple Anaplastic large cell lymphoma, ALK-negative, extranodal and solid organ Mature T/NK-cell lymphomas, unspecified, unspecified site 2 Mature T/NK-cell lymphomas, unspecified, lymph nodes of head, face, and Mature T/NK-cell lymphomas, unspecified, intrathoracic lymph nodes 2 Mature T/NK-cell lymphomas, unspecified, intra-abdominal lymph nodes 2 Mature T/NK-cell lymphomas, unspecified, lymph nodes of axilla and upper Mature T/NK-cell lymphomas, unspecified, lymph nodes of inguinal region and lower Mature T/NK-cell lymphomas, unspecified, intrapelvic lymph nodes 2 Mature T/NK-cell lymphomas, unspecified, spleen 2 Mature T/NK-cell lymphomas, unspecified, lymph nodes of multiple 2 Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ 2 Cutaneous T-cell lymphoma, unspecified, unspecified site 2 Cutaneous T-cell lymphoma, unspecified lymph nodes of head, face, and Cutaneous T-cell lymphoma, unspecified, intrathoracic lymph nodes 2 Cutaneous T-cell lymphoma, unspecified, intra-abdominal lymph nodes 2 Cutaneous T-cell lymphoma, unspecified, lymph nodes of axilla and upper Cutaneous T-cell lymphoma, unspecified, lymph nodes of inguinal region and lower Cutaneous T-cell lymphoma, unspecified, intrapelvic lymph nodes 2 Cutaneous T-cell lymphoma, unspecified, spleen 2 Cutaneous T-cell lymphoma, unspecified, lymph nodes of multiple 2 Cutaneous T-cell lymphoma, unspecified, extranodal and solid organ 2 Other mature T/NK-cell lymphomas, unspecified site 2 Other mature T/NK-cell lymphomas, lymph nodes of head, face, and neck Other mature T/NK-cell lymphomas, intrathoracic lymph nodes Other mature T/NK-cell lymphomas, intra-abdominal lymph nodes Other mature T/NK-cell lymphomas, lymph nodes of axilla and upper limb Other mature T/NK-cell lymphomas, lymph nodes of inguinal region and lower limb Other mature T/NK-cell lymphomas, intrapelvic lymph nodes Other mature T/NK-cell lymphomas, spleen Other mature T/NK-cell lymphomas, lymph nodes of multiple Other mature T/NK-cell lymphomas, extranodal and solid organ Unspecified B-cell lymphoma, unspecified site 2 Unspecified B-cell lymphoma, lymph nodes of head, face, and Unspecified B-cell lymphoma, intrathoracic lymph nodes 2 Unspecified B-cell lymphoma, intra-abdominal lymph nodes 2 Unspecified B-cell lymphoma, lymph nodes of axilla and upper Unspecified B-cell lymphoma, lymph nodes of inguinal region and lower Unspecified B-cell lymphoma, intrapelvic lymph nodes 2 Unspecified B-cell lymphoma, spleen 2 Unspecified B-cell lymphoma, lymph nodes of multiple 2 Unspecified B-cell lymphoma, extranodal and solid organ 2 Mediastinal (thymic) large B-cell lymphoma, unspecified site 2 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of head, face, and neck Mediastinal (thymic) large B-cell lymphoma, intrathoracic lymph nodes C85.23 Mediastinal (thymic) large B-cell lymphoma, intra-abdominal lymph nodes C85.24 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of axilla and upper limb C85.25 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of inguinal region and lower limb C85.26 Mediastinal (thymic) large B-cell lymphoma, intrapelvic lymph nodes C85.27 Mediastinal (thymic) large B-cell lymphoma, spleen C85.28 Mediastinal (thymic) large B-cell lymphoma, lymph nodes of multiple C85.29 Mediastinal (thymic) large B-cell lymphoma, extranodal and solid organ C85.80 Other specified types of non-hodgkin lymphoma, unspecified site 2 C85.81 Other specified types of non-hodgkin lymphoma, lymph nodes of head, face, and neck C85.82 Other specified types of non-hodgkin lymphoma, intrathoracic lymph nodes C85.83 Other specified types of non-hodgkin lymphoma, intra-abdominal lymph nodes C85.84 Other specified types of non-hodgkin lymphoma, lymph nodes of axilla and upper limb C85.85 Other specified types of non-hodgkin lymphoma, lymph nodes of inguinal region and lower limb C85.86 Other specified types of non-hodgkin lymphoma, intrapelvic lymph nodes C85.87 Other specified types of non-hodgkin lymphoma, spleen C85.88 Other specified types of non-hodgkin lymphoma, lymph nodes of multiple C85.89 Other specified types of non-hodgkin lymphoma, extranodal and solid organ C85.90 Non-Hodgkin lymphoma, unspecified, unspecified site 2 C85.91 Non-Hodgkin lymphoma, unspecified, lymph nodes of head, face, and C85.92 Non-Hodgkin lymphoma, unspecified, intrathoracic lymph nodes 2 C85.93 Non-Hodgkin lymphoma, unspecified, intra-abdominal lymph nodes 2 C85.94 Non-Hodgkin lymphoma, unspecified, lymph nodes of axilla and upper C85.95 Non-Hodgkin lymphoma, unspecified, lymph nodes of inguinal region and lower C85.96 Non-Hodgkin lymphoma, unspecified, intrapelvic lymph nodes 2 C85.97 Non-Hodgkin lymphoma, unspecified, spleen 2 C85.98 Non-Hodgkin lymphoma, unspecified, lymph nodes of multiple 2 C85.99 Non-Hodgkin lymphoma, unspecified, extranodal and solid organ 2 C86.0 Extranodal NK/T-cell lymphoma, nasal type C86.1 Hepatosplenic T-cell lymphoma C86.2 Enteropathy-type (intestinal) T-cell lymphoma C86.3 Subcutaneous panniculitis-like T-cell lymphoma C86.4 Blastic NK-cell lymphoma C86.5 Angioimmunoblastic T-cell lymphoma C86.6 Primary cutaneous CD30-positive T-cell proliferations C88.0 Waldenstrom macroglobulinemia C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma] C90.00 Multiple myeloma not having achieved remission C90.01 Multiple myeloma in remission C90.02 Multiple myeloma in relapse C96.4 Sarcoma of dendritic cells (accessory cells) C96.9 Malignant neoplasm of lymphoid, hematopoietic and related tissue, unspecified 2 C96.Z Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue D55.0 Anemia due to glucose-6-phosphate dehydrogenase [G6PD] deficiency D55.1 Anemia due to other disorders of glutathione metabolism D55.2 Anemia due to disorders of glycolytic enzymes D55.3 Anemia due to disorders of nucleotide metabolism D55.8 Other anemias due to enzyme disorders D55.9 Anemia due to enzyme disorder, unspecified 2 D56.0 Alpha thalassemia D56.1 Beta thalassemia D56.2 Delta-beta thalassemia 401