How To Use CPT Code 80506

CPT 80506 describes the prolonged pathology clinical consultation service provided by a pathologist. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 80506?

CPT 80506 can be used to report the prolonged pathology clinical consultation service provided by a pathologist. This code is used when the pathologist spends additional time beyond the initial 60 minutes on a consultation, at least 15 minutes or more, to further evaluate and provide recommendations for a complex clinical problem. It is important to note that CPT 80506 should only be used in conjunction with CPT 80505.

2. Official Description

The official description of CPT code 80506 is: ‘Pathology clinical consultation; prolonged service, each additional 30 minutes (List separately in addition to code for primary procedure).’ It is important to note that CPT 80506 should be used in conjunction with CPT 80505 and should not be reported for less than 15 additional minutes of pathology clinical consultation time.

3. Procedure

1. Upon the request of a physician or other qualified healthcare provider, the pathologist performs a consultation to aid in determining a diagnosis, further testing needs, or treatment options for a complex clinical problem.
2. The pathologist may conduct a comprehensive review of the patient’s history and medical records to gain a better understanding of the case.
3. If the pathologist spends at least 75 minutes on the consultation date, CPT 80505 is reported for the first 60 minutes, and one unit of CPT 80506 is reported for each additional 30 minutes, or at least 15 additional minutes.
4. The pathologist thoroughly evaluates the diagnostic test findings and provides recommendations based on their medical judgment.
5. The consultation may involve discussions with the referring physician or other healthcare providers to clarify abnormal, conflicting, or equivocal test results.
6. The pathologist documents the time spent on the consultation and the complexity of the clinical problem.

4. Qualifying circumstances

CPT 80506 is used for pathology clinical consultations that involve highly complex clinical problems requiring a high level of medical judgment. The consultation may include a comprehensive review of patient history and medical records. It is important to note that CPT 80506 should only be reported if the pathologist spends at least 15 additional minutes beyond the initial 60 minutes on the consultation.

5. When to use CPT code 80506

CPT code 80506 should be used when the pathologist spends at least 15 additional minutes beyond the initial 60 minutes on a pathology clinical consultation for a highly complex clinical problem. It is important to use this code in conjunction with CPT 80505 and only report it if the additional time spent meets the qualifying circumstances.

6. Documentation requirements

To support a claim for CPT 80506, the pathologist must document the following information:

• The reason for the consultation and the complexity of the clinical problem
• The time spent on the consultation, including the initial 60 minutes and the additional 15 minutes or more
• A comprehensive review of the patient’s history and medical records
• Evaluation of diagnostic test findings and recommendations provided
• Any discussions with referring physicians or other healthcare providers
• Signature of the pathologist performing the consultation

7. Billing guidelines

When billing for CPT 80506, ensure that the pathologist has spent at least 15 additional minutes beyond the initial 60 minutes on the consultation. This code should be reported in conjunction with CPT 80505. It is important not to report CPT 80506 for less than 15 additional minutes of pathology clinical consultation time. Additionally, do not use CPT codes 80503, 80504, 80505, or 80506 in conjunction with codes 88321, 88323, or 88325.

8. Historical information

CPT 80506 was added to the Current Procedural Terminology system on January 1, 2022. There have been no updates to the code since its addition.

9. Examples

1. A pathologist spends an additional 30 minutes beyond the initial 60 minutes on a consultation to further evaluate and provide recommendations for a complex clinical problem.
2. During a pathology clinical consultation, the pathologist spends an additional 45 minutes beyond the initial 60 minutes to thoroughly evaluate abnormal test results and discuss treatment options with the referring physician.
3. A pathologist spends an additional 15 minutes beyond the initial 60 minutes on a consultation to review the patient’s medical records and provide recommendations for further testing.
4. During a pathology clinical consultation, the pathologist spends an additional 30 minutes beyond the initial 60 minutes to clarify conflicting test results and suggest appropriate follow-up procedures.
5. A pathologist spends an additional 60 minutes beyond the initial 60 minutes on a consultation to extensively review the patient’s history, medical records, and diagnostic test findings, providing a comprehensive evaluation and treatment plan.
6. During a pathology clinical consultation, the pathologist spends an additional 20 minutes beyond the initial 60 minutes to discuss complex test results with the referring physician and provide guidance on further diagnostic procedures.
7. A pathologist spends an additional 45 minutes beyond the initial 60 minutes on a consultation to thoroughly analyze the patient’s medical records, diagnostic test findings, and treatment options, providing detailed recommendations for the referring physician.
8. During a pathology clinical consultation, the pathologist spends an additional 30 minutes beyond the initial 60 minutes to review the patient’s history, medical records, and test results, offering expert advice on the diagnosis and treatment of a complex clinical problem.