L861

PDF page 476 / J62

DIAGNOSTIC AND THERAPEUTIC PROCEDURES
LABORATORY MEDICINE
   L866 SURGICAL PATHOLOGY, LEVEL 6.
    Gross and microscopic examination of the following specimens:
    Bone (resection); breast (mastectomy with regional lymph nodes); colon (segmental resection
    for neoplasm); colon (total resection); extremity (disarticulation); fetus (with dissection); larynx
    (partial or total resection with regional lymph nodes); lung (partial or total resection);
    oesophagus (partial or total resection); pancreas (partial or total resection); prostate (radical
    resection); small intestine (resection for neoplasm); soft tissue neoplasm (extensive resection);
    stomach (partial or total resection for neoplasm); testis (neoplasm); tongue (resection for
    neoplasm); tonsil (resection for neoplasm); urinary bladder (partial or total resection); uterus
    with or without fallopian tubes and ovaries (neoplasm other than leiomyoma); vulva (partial or
    total resection).
   L867 SURGICAL PATHOLOGY
    Gross and microscopic examination of specimens not listed in Levels 2 through 6.
    Payment rules:
    1. The unit of a service in Surgical Pathology and Cytopathology is a specimen. A specimen is
      tissue that is identified and submitted for individual and separate examination and diagnosis.
    [Commentary:
    Surgical Pathology codes L861 through L866 denote increasing levels of physician work
    associated with examination of the specimens listed in the respective service code definitions.]
    2. When the examination of a specimen requires any of the services listed under Special
      Procedures and Interpretation - Histology or Cytology, such services are eligible for payment
      in addition to any of the following services (when rendered):
        a.services listed under Anatomic Pathology - Surgical Pathology,
        b.services listed under Anatomic Pathology – Cytopathology; or
        c.a Diagnostic Laboratory Medicine Consultation (A585/C585) as listed in the "Consultation
          and Visits" section of the Schedule.
    3. Cytology smears fees are payable in each case for which the physician is responsible
      whether or not all slides are personally examined by the physician.
    [Commentary:
    1.For the technical components of Laboratory Medicine (L001 to L799 and L900 codes), please
      refer to the separate Schedule of Benefits for Laboratory Services.
    2.See section 37.1 of regulation 552 under the Health Insurance Act for additional information
      regarding payment and insurability of Laboratory services.]

Master, record 3625. Record Layout PDF, page 1.

L86120260401999999990000005350000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.