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A clinical pathology consultation is a service rendered by the pathologist in response to a request from the attending physician in relation to a test result(s) requiring additional medical interpretive judgment. The pathologist's medical interpretive judgment must be documented in a written report.
The consultation begins when the pathologist receives the request from the attending physician and ends when the pathologist has fulfilled all requirements outlined in the request. The pathologist may review the results of several tests at different intervals during the course of the time specified in the request. For example, the attending physician may request the review of test results for a given period of time, such as, every four hours for a 24-hour period. This would be considered one consultation. Prior to 1/1/2022 CPT code 80500 or 80502 should be reported one time for each completed consultation. Effective 1/1/2022 CPT code 80503, 80504, or 80505 should be reported one time for each completed consultation and add-on code 80506 (prolonged service) should be reported with 80505 for each additional 30 minutes.
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The coding guidelines outlined in Coding Policy should not be used in lieu of the Member's specific benefits plan language.
1/2003: Policy developed
12/30/21: Added 1/1/2022 code changes.
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