College of American Pathologists

  New Use for CPT 80500


Reprinted from March 1996 CAP TODAY

Pathologists should use CPT code 80500 for review of cytopathology smears and histopathology slides to determine the causes of discrepancies, the American Medical Association’s CPT Editorial Panel advises.

CPT code 80500 is for clinical pathology consultation; limited, without review of patient’s history and medical records. Its use requires a written report in response to a request for the consultation by an attending physician.

The CPT advice comes in response to College requests for a new code for the examination of discordant cytology and pathology slide(s) as required by CLIA ’88. CLIA cytology sections 493.1257 (d) (2) and (3) say the laboratory must compare clinical information, when available, with cytology reports and must compare all malignant and premalignant gynecology reports with the histopathology report, if available in the laboratory either on site or in storage, and determine the causes of discrepancies. In addition, each patient with a current high-grade or above intraepithelial lesion (moderate dysplasia or CIN-2 or above), the laboratory must review all normal or negative gynecologic specimens received within the previous five years, if available in the laboratory either on site or in storage. If significant discrepancies are found that would affect patient care, the laboratory must notify the patient’s physician and issue an amended report.

In requesting a new code for this service, the College noted that the service is now the expected standard of practice and can require considerable physician time and effort. It is provided to determine the reason for the discordance so further studies can be suggested or a clinical course of action can be determined, not for the purpose of quality control of the previously interpreted smears.

The CPT Editorial Panel reviews requests for revised or new CPT codes and defines the use of existing codes. The Panel comprises physicians of various specialties and includes representatives of the Health Insurance Association of America, Blue Cross and Blue Shield Association, and Health Care Financing Administration. In advising that 80500 be used for these services, the panel also noted that the billing physician should provide supplementary information to the insurer explaining the specific service.