Comprehensive Guide to Laboratory Billing and CPT Codes for Diagnostic Tests

Introduction:

Diagnostic tests covers a wide range of laboratory services like blood tests, urine tests, and molecular diagnostic and tumor markers. For all these important diagnostic tests, CPT Codes are used to translate medical billing services into medical billing claims for reimbursement. Accurate use of CPT codes for diagnostic tests ensure financial stability of healthcare institutions. This article will specifically discuss comprehensive list of CPT codes used for laboratory billing services linked to blood tests, urine tests, and services related to tumor markers.

Pathology and Laboratory Billing Codes:

The CPT Codes for pathology and laboratory services range from 80047 to 89398. These codes can be used to document all diagnostic tests and laboratory services for the laboratory billing process. This range of CPT Codes covers a wide array of laboratory services, such as molecular diagnostics/testing, microbiology-related services, and tests concerning to tissue pathology.

Types of Laboratory Tests

The following are some of the more common laboratory tests:

1. Urine Tests
2. Blood Tests
3. Tumor markers 

1. Urine Tests

Urinalysis laboratory test is used for detecting various chemicals, cells, bacterial infections, viruses, and excessive proteins in a urine sample.

Following are a few techniques used in Urinalysis.

Techniques used in Urinalysis:

• Visual exam: Visual examination means just relying on the visual appearance of urine.
• Dipstick test: A dipstick is a thin plastic stick with strips of chemicals on it. It is placed in the urine, and the chemical strips change color with respect to certain substances, acting as an indicator. The dipstick test is effective for detecting Acidity, Concentration, Protein, sugar, Ketones, Bilirubin, and blood infections.
• Microscopic exam: Few drops of urine are examined under a Microscope to detect foreign specimens. This technique is effective for examining White blood cells, red blood cells, Bacteria, yeast/parasites, Casts, and Crystals.

CPT and HCPCS Codes for Commonly Performed Tests by using Urine Source

Sr. no	Test Name	CPT Code	Technique	Description
1.	UA Dip	81003	dipstick	This CPT Code is used for the UA Dip test, which examines Acidity, Concentration, and Protein, the presence of sugar, Ketones, Bilirubin, Ketones, and blood infections.
2.	UA Microscopic	81001	Microscopic exam	This CPT Code is used for UA Microscopic testing to examine White blood cells, red blood cells, Bacteria, yeast/parasites, Casts, and Crystals.

2. Blood Tests

Blood tests are performed for tracing different kinds of blood chemistries and markers of inflammation and genetics.

Techniques used in Blood Tests:

1. Immunoassays:

 Immunoassays are special types of blood tests used for detecting interactions between immunoglobulin, commonly referred to as an antibody, and a substance that the immunoglobulin recognizes, called an antigen.

Immunoassay tests for antibodies include:

Sr. no	Test Name	CPT
1.	Rheumatoid Factor	86431 (quantitative) 86430 (qualitative)
2.	Hepatitis B Surface Antibody	86317 (quantitative) 86706 (qualitative)

Immunoassay Includes:

• ELISA test (Enzyme-Linked Immuno Sorbent Assay) detects and counts antibodies, antigens, proteins, and hormones in bodily fluid samples. Another name for this test is EIA test.
• Western Blot: This is an immunoassay test method used for detecting specific proteins in blood and tissue. The process begins with the extraction of proteins from cells/tissues followed by separation based on size in gel electrophoresis, typically SDS-PAGE. Separated proteins can then be transferred to a membrane, commonly nitrocellulose or PVDF, which makes it easier for detection. An example of its use includes Lyme disease testing. CPT Code for detecting Lyme disease, Line Blot is 86617.

2. Molecular Diagnostics Technique:

Fluorescence in situ Hybridization (FISH): This molecular testing method uses fluorescent probes to evaluate genes and DNA sequences on chromosomes. This technique highlights the presence of extra gene copies that may be a duplicated gene or the missing genes, also known as translocated genes.  

PCR: PCR is a method used to prepare billions of copies of specific DNA sequences. This technique consists of three steps:

• Denaturation,  
• Annealing,  
• Extension

1. CPT Codes for Blood Test:         

1. Anti-nuclear Antibody (ANA) Test: ANA test measures blood levels of antibodies often present in individuals with autoimmune disorders. It is particularly used of rheumatic diseases such as lupus and rheumatoid arthritis.

• CPT Code 86038 is used for Anti-Nuclear Antibodies by Indirect Fluorescent Antibody.

• Blood Chemistry Study: Blood samples are examined to measure specific substances released into the blood by organs and tissues. This test also help in assessing metabolic and organ function. Following CPT Codes can be used for detecting particular substances:
  • Potassium Detection: CPT Code 84132 is used.
  • Creatinine Detection: CPT Code 82565 is used.
  • Bilirubin Detection: CPT Code 82247 is used.

• Blood Lipid Profile: Lipid profile test evaluates levels types of fats in the blood. It includes cholesterol and triglycerides that are important for calculating cardiovascular risk. Following CPT Codes are used for Lipid Profile testing.
  • CPT Code 80061 is used for total Lipid Profile testing.
  • CPT Code 82465 is used for total Cholesterol testing.
  • CPT Code 83718 is used to test HDL Cholesterol.
  • CPT Code 84478 is used for detecting Triglycerides.
  • CPT Code 83721 is used for detecting LDL.
• B-type Natriuretic Peptide (BNP) Testing: BNB Test evaluates levels of BNP hormone released from the heart-ventricles in response to high wall tension.
• CPT Code 83880 is used for BNP Blood test.

• Complete Blood Count (CBC): CBC test measures the size, number, and maturity of different blood cells. This test provides valuable information about overall health and disorders like anemia/infection.

• CPT Code 85025 is used for CBC test with Differential.
• CPT Code 85027 is used for CBC test without Differential.

• Creatinine Test: Creatinine Test evaluates kidney function by measuring creatinine levels to indicate potential kidney disease.
• CPT Code 82565 is used for Creatinine blood test.

• C – reactive protein Test- CRP Test: CRP test examines the presence of inflammation in the body, which can indicate various health conditions.

• CPT Code 86140 is used for CRP test.

• Erythrocyte Sedimentation Rate (ESR): ESR test measures; how quickly red blood cells fall to the bottom of a test tube. This test is useful to provide information about inflammation levels in the body. High ESR level is an indication of inflammation in the body.

• CPT Code 85651 is used for ESR blood test.

• CPT Codes for Thyroid Function Tests
• CPT Code  84443 is used for Thyroid-stimulating hormone (TSH)
• CPT Code  84436 is used for measuring level of Free T4 (thyroxine)
• CPT Code  84479 is used for measuring level of Free T3 (triiodothyronine)
• Vitamin D Testing
• CPT Code  82306 is used for detecting Vitamin D, 25-hydroxy

Liver Function Tests:

Liver function tests (LFTs) include all kind of blood tests that can examine functionality of human liver. These tests can efficiently assess various enzymes, proteins, and substances responsible for liver disorder.  

There we have CPT Codes for commonly performed liver function tests along with their CPT Code s:

1. Serum Bilirubin Test: This test measures the levels of bilirubin in the blood to indicate liver dysfunction, bile duct obstruction, and haemolysis.
2. CPT Code 82247 is used for Serum Bilirubin Test.
3. Serum Albumin Test: Evaluates the level of albumin, a protein produced by the liver, which helps maintain blood volume and pressure. Low levels can indicate liver disease or other medical conditions.
4. CPT Code 82040 is used for Serum Albumin Test.
5. Prothrombin Time—PTT Test: The PTT Test assesses how long it takes for blood to clot. It provides insights into the liver’s ability to produce clotting factors. Prolonged clotting times may indicate liver dysfunction.
6. CPT Code 85610 is used for PTT test.
7. Alanine Transaminase—ALT Test: The ALT test measures the level of alanine aminotransferase, an enzyme primarily found in the liver. Elevated levels can indicate liver cell damage or inflammation.
8. CPT Code 84460 is used for ALT test.
9. Aspartate Transaminase—AST Test: The AST test measures the level of aspartate transaminase, an enzyme found in the liver and heart. Elevated AST levels can indicate liver disease or heart problems.
10. CPT Code 84460 is used for AST test.
11. Lactic Dehydrogenase (LDH) Test: The LDH test examines tissue damage and helps diagnose liver disease. LDH levels may rise due to liver injury or other conditions affecting various organs.
12. CPT Code 83615 is used for LDH test.

Common CPT Codes for measuring Lever Functioning:

• CPT Code 84460 is used to analyze Alanine Aminotransferase (ALT). It is an enzyme that helps detect liver damage and inflammation.
• CPT Code 84450 is used to analyze Aspartate Aminotransferase (AST). It is an enzyme that helps assess liver and muscle damage.
• CPT Code 84075 is used to analyze Alkaline Phosphatase (ALP). It is an enzyme that indicates liver, bone and bile duct issues.
• CPT Code 82247 is used to analyze Total Bilirubin. It is a substance that helps detect liver dysfunction or hemolytic anemia.
• CPT Code 82248 is used to analyze Direct Bilirubin (Conjugated Bilirubin), which indicates liver dysfunction or bile duct obstruction.
• CPT Code 82040 is used to analyze Albumin, a protein that helps assess liver function and nutritional status.
• CPT Code 84155 is used to analyze Total Protein. It is a test that evaluates liver and kidney function as well as nutritional status.
• CPT Code 82977 is used to analyze Gamma-Glut amyl Transferase (GGT). It is an enzyme that indicates liver or bile duct issues, and alcohol consumption.
• CPT Code 85610 is used to analyze Prothrombin Time (PT). It is a test that assesses liver function by measuring blood clotting time.
• CPT Code 83615 is used to analyze Lactate Dehydrogenase (LDH). It is an enzyme that helps identify liver, muscle, and heart damage.
• CPT Code 80076 is used for a Liver Function Panel. It includes tests like ALT, AST, ALP, bilirubin, and albumin to assess overall liver health.

3. Tumor Markers

Tumor markers are substances released by cancer cells into the blood and urine. These substances are created by body in response to cancer cells. Tumor markers are used to evaluate how well a patient has responded to treatment and to check for tumor recurrence.

Techniques used in Tumor Markers:

Different kinds of techniques are used to detect and analyze tumor markers by laboratories. These techniques are crucial for accurate diagnosis of cancer type and also plays an imperative role in laboratory billing procedure.

1. Immunoassays – ELISA and Chemiluminescence:

• Enzyme-linked immunosorbent Assay (ELISA) is a well-known technique of detecting specific proteins—antigens related to tumors—in blood and urine samples. ELISA tests can quantify tumor markers like CA 125 for ovarian cancer and Prostate-Specific Antigen (PSA) for prostate cancer.

• Chemiluminescence Immunoassay (CLIA) offers higher sensitivity as compared to traditional methods. It is considered as an ideal choice for detecting low concentrations of tumor markers. CLIA is frequently used for markers such as beta-human chorionic gonadotropin – βhCG for gestational trophoblastic disease and alpha-fetoprotein for liver cancer.

2. Radioimmunoassay –RIA:

Radioimmunoassay is a technique in which radioactive isotopes are used to detect tumor markers. This technique provides high sensitivity for measuring hormones and cancer antigens. It is useful for identifying markers like thyroglobulin and insulin.

Types of Tumor Markers with CPT Code

Tumor markers are substances found in blood, urine, and tissues showing presence of cancer. These markers are vibrant for diagnosis and evaluating the recurrence of cancer. Below are some commonly performed tumor markers along with their respective CPT Code s:

1. Prostate-Specific Antigen (PSA): PSA levels are primarily used to measure prostate cancer progression, treatment response, and potential tumor recurrence.
2. CPT Code 84153 is used for PSA test.
3. CA 125: Elevated CA 125 levels are commonly associated with ovarian cancer but can also indicate other malignancies. It is used for detecting cancers of the uterus, cervix, pancreas, liver, colon, breast, lung, and digestive tract.
4. CPT Code 86304 is used for testing high CA 125 levels.
5. Carcinoembryonic Antigen –CEA: CEA is a tumor marker primarily associated with colorectal cancer but can also be elevated in other cancers, such as breast and lung cancers. It is often used to monitor treatment response and detect recurrence.
6. CPT Code 82378 is used for CEA.
7. CA 19-9: CA 19-9 test is primarily linked with pancreatic cancer but can also be used to detect increased levels of colorectal, gastric and bile duct cancers. It is useful for monitoring treatment efficacy and disease progression.
8. CPT Code 86301 is used for CA 19-9.

Common Tumor Markers with CPT Code

• CPT Code 84153 is used for Prostate-Specific Antigen (PSA). It is a tumor marker for prostate cancer.
• CPT Code 82378 is used for Carcinoembryonic Antigen (CEA), a marker for colorectal cancer.
• CPT Code 81715 is used for Alpha-Fetoprotein (AFP), a marker for liver cancer.
• CPT Code 86304 is used for Cancer Antigen 125, a marker for ovarian cancer.
• CPT Code 86300 is used for Cancer Antigen 19-9, a marker for pancreatic cancer.
• CPT Code 84702 is used for Human Chorionic Gonadotropin (chg.), a marker for testicular cancer.
• CPT Code 86300 is used for Squamous Cell Carcinoma Antigen (SCC), a marker for squamous cell carcinoma.
• CPT Code 84436 is used for Thyroglobulin, a marker for thyroid cancer.
• CPT Code 88360 is used for HER2/net, a marker for breast cancer.
• CPT Code 81211 is used for BRCA1/BRCA2 Gene Mutation Testing, a test for breast and ovarian cancer risk.
• CPT Code 83883 is used for Beta-2 Macroglobulin, a marker for multiple myeloma.
• CPT Code 83615 is used for Lactate Dehydrogenase (LDH), a marker for lymphoma and leukaemia.
• CPT Code 82668 is used for Neuron-Specific Enolase (NSE), a marker for small cell lung cancer.
• CPT Code 83953 is used for Chromogranin A, it is also a tumor marker for neuroendocrine tumours.

Conclusion:

                 Laboratory billing and coding plays an imperative role for accurate reimbursements and smooth healthcare working. Laboratory services specifically include: blood tests, urine tests, molecular diagnostics, and tumor markers. Proper use of CPT codes ensures financial stability of healthcare institutions. It allows healthcare professionals to focus on patient care and HIPAA compliance. Each category of lab testing has unique CPT Codes used for submitting claims for laboratory services. These claims ensures timely reimbursement from insurance companies to improve revenue cycle management (RCM). Laboratories can also take assistance from reputed laboratory billing firms like Curecloudmd to ensure complete HIPAA compliance.