You Be the Coder:
Chem 18 Panel
Published on Tue Oct 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the
answer.
Question: Can you tell me what to bill to Medicare for a "chem 18"? Unfortunately, the only information I have is that this test is called a "chem 18."
Michigan Subscriber
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Answer: Medicare recognizes the laboratory panels defined by the American Medical Association and listed in the Common Procedural Terminology (CPT) manual. The tests listed in the CPT with each panel code are the defined components of that code for Medicare purposes.
To bill for your "chem 18," you need to review the list of tests in the chem 18 and compare it to the panels recognized by Medicare. Medicare will accept the bill as long as you do the following:
Use the organ and disease panels listed in the CPT for the tests that are included in a panel;
List each test separately; or,
Use a combination of the CPT panels and individually reported tests.
Your Medicare carrier will count the number of nonduplicated automated tests involved in the service to a patient on a given day and pay based on the total number.
If the CPT panels are used to report lab tests, it is essential that every test in the panel reported be medically necessary for the patient involved. If a particular test in a panel is not medically necessary, bill using the CPT codes for the specific medically necessary tests instead of using the CPT code for the panel. Make sure the medical necessity is well documented in the patient record.
On a related issue, although non-Medicare payers accept 36415* (Routine venipuncture or finger/heel/ear stick for collection of specimen[s]) to bill for specimen collection done in the office, Medicare does not. For Medicare patients, G0001 (Routine venipuncture for collection of specimen[s]) should be used for specimen collection. Medicare has its own code because Medicare will only pay for collection by venipuncture and will not cover capillary sticks, which are included in 36415. Medicare requires the use of G0001 to ensure that physicians do not claim payment based on collection of a specimen by capillary stick. And, for Medicare, only one specimen-collection charge can be billed per encounter regardless of the number of specimens collected.
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