Pathology/Lab Coding Alert

Ionized calcium distinguishes new basic metabolic panel Get ready to change how you code the basic metabolic panel with ionized calcium -- and avoid a tempting payment pitfall. Although CMS had not finalized the 2008 clinical laboratory fee schedule (CLFS) at press time, the expected crosswalk from existing panel code 80048 to new panel code 80047 means you-d get the same pay for either panel. That pricing could sell labs short because labs typically use separate instrumentation for the ionized calcium in addition to the seven other tests of the metabolic panel, says Katharine Ayres, MT (ASCP), CT, director of legislative and regulatory affairs for Clinical Laboratory Managers Association (CLMA). Make Sure You Code for Your Work -- Not Your Pay Regardless of the pay-up, you should select the code that most accurately describes which basic metabolic panel your lab performs. Before Jan. 1, 2008, you had only one choice -- 80048. Now you have two choices: - 80047 -- Basic metabolic panel (Calcium, ionized) - 80048 -- Basic metabolic panel (Calcium, total). Last year, the 80048 code definition did not specify that the test involved a total calcium reading. Although the code definition has changed, the tests included in the panel have not. Now, as last year, the 80048 panel must include the following tests: calcium (82310, Calcium; total), carbon dioxide (82374), chloride (82435), creatinine (82565), glucose (82947), potassium (84132), sodium (84295), and urea nitrogen (BUN) (84520). In contrast, the new 80047 panel includes 82330 (Calcium; ionized) instead of 82310. All other tests in the 80047 panel are the same as 80048 (carbon dioxide, chloride, creatinine, glucose, potassium, sodium and BUN). Do this: When reporting these services, you need to choose the code based on which basic metabolic panel the lab performs -- and that depends entirely on the particular calcium test involved (ionized versus total), says Kent Moore, manager of healthcare financing and delivery systems for the American Academy of Family Physicians in Leawood, Kan. Impact: If the 80047 pricing crosswalks to 80048, which paid $11.83 last year, labs stand to lose money on the new panel. Medicare paid $19.09 for just 82330 in 2007 -- and ionized calcium is only one, separately performed test in the new panel. That's why some professional organizations, such as CLMA, recommended a higher crosswalk to ATP07 (Automated test panel pricing code, 7 tests) for $11.42 plus 82330 for $19.09 (total $30.51), Ayres says. Follow 3 -Panel Rules- to Pick the Right Code Every Time Payment for a lab panel with a unique CPT code is usually less than payment for all of the component-test CPT codes combined. Red flag: Although the reimbursement equation might tempt labs to code the component codes [...]