CPT Radiology, Pathology/Laboratory, and Medicine Coding
What this domain tests
This section covers radiology professional and technical components, laboratory panels and CLIA, pathology specimens and stains, and medicine services such as immunizations, injections, and time-based therapies.
Core rules
- Radiology codes have a global service; modifier 26 is the professional component and TC the technical component. In a hospital, the physician usually bills 26 and the facility bills TC.
- Contrast, supervision, and interpretation must be documented. Radiologic supervision and interpretation codes are separate when listed.
- Laboratory panels are reported as panels when all listed tests are performed; do not unbundle into individual tests.
- CLIA-waived tests carry modifier QW when required by the payer.
- Pathology coding depends on specimen type and preparation; special stains and immunohistochemistry are add-on or separate codes when documented.
- Medicine services may be time-based; time must be documented and meets a threshold.
Worked example
A hospital performs a two-view chest X-ray and the radiologist interprets it. The hospital bills 71046-TC for the technical component. The radiologist reports 71046-26 for the interpretation. Billing 71046 globally would duplicate the hospital's technical charge and is a common cause of denial.
Traps
Billing global radiology in a hospital; unbundling a lab panel; missing QW; reporting a stain without documentation; using a time-based code without documented time; confusing professional and technical components.