Pathology/Lab Coding Alert

Never list ATP codes on claims.

A physician orders a panel of tests, your lab bills one of CPT®’s 10 codes from the “Organ or Disease-Oriented Panels” section and you get paid. Simple enough — right?

Not so fast: You might get confused if the physician makes up her own panel of tests, or if some of the tests are automated and some are not. Or you might wonder if you should use the Automated Test Panel (ATP) codes on the Clinical Laboratory Fee Schedule (CLFS).

Read on for expert tips to make sure you get your panel coding right — every time.

Tip 1: Bill Panel Codes Only When Inclusive

CPT® provides 10 panel codes in the range 80047-80076 with names like “electrolyte panel” or “obstetric panel.” Each code lists the tests that comprise the panel, like this:

80053 — Comprehensive metabolic panel

This panel must include the following:

Albumin (82040)
Bilirubin, total (82247)
Calcium, total (82310)
Carbon dioxide (bicarbonate) (82374)
Chloride (82435)
Creatinine (82565)
Glucose (82947)
Phosphatase, alkaline (84075)
Potassium (84132)
Protein, total (84155)
Sodium (84295)
Transferase, alanine amino (ALT) (SGPT) (84460)
Transferase, aspartate amino (AST) (SGOT) (84450)
Urea nitrogen (BUN) (84520)

Must: Notice that the code definition states that the panel must include the test procedures that follow. “You should not report the panel code if you do not perform every test listed in the panel definition,” explains William Dettwyler, MTAMT, president of Codus Medicus, a laboratory coding consulting firm in Salem, Ore.

Tip 2: Know When to Report Individual Test Codes

To meet specific clinical parameters, physicians or labs sometimes design their own “panel” or collection of tests that don’t align with one of the ten CPT® panels. Or, physicians may order specific individual tests that aren’t an exact match for a listed panel code. You need to know how to code the lab’s work in those circumstances.

Less: If you perform fewer tests than listed in a CPT® panel definition, don’t code the panel. Instead, you should separately code the individual tests using the appropriate CPT® code for each test.

Exception: If there’s a smaller yet similar panel, you might be able to use the smaller panel code. For instance, 80048 (Basic metabolic panel [calcium total]) includes nine of the 14 tests included in 80053. You should always check what tests are included in the other panel codes before you revert to coding the tests individually.

More: On the other hand, if you perform additional tests to those listed in a panel definition, you should report the panel code plus the CPT® codes for each additional test that you perform.

Overlap: CPT® provides instruction for this scenario: “Do not report two or more panel codes that include any of the same constituent tests performed from the same patient collection. If a group of tests overlaps two or more panels, report the panel that incorporates the greater number of tests to fulfill the code definition and report the remaining tests using individual test codes.”

Tip 3: Don’t Confuse Payment Scheme With Correct Coding

Coders may be tempted to use a panel code even though the lab didn’t perform one of the listed tests because they’re afraid that billing the tests individually will result in overpayment. Never fear — Medicare has a payment scheme to make sure you’re not overpaid. Stick with correct coding outlined in Tip 2 and you’ll get paid for your work fair and square.

How it works: Medicare pays for 22 specific tests under the “Automated Multi-Channel Chemistry” (AMCC) system. Whether you bill any of those tests using a panel code or individually, Medicare pays for them the same.

The payment is based on the following ATP payment scale, which you can find on the Clinical Laboratory Fee Schedule (CLFS, 2013 national limit amount):

ATP02: 1 or 2 tests; $ 7.16
ATP03: 3 tests; $ 9.13
ATP04: 4 tests; $ 9.64
ATP05: 5 tests; $10.76
ATP06: 6 tests; $10.79
ATP07: 7 tests; $11.23
ATP08: 8 tests; $11.63
ATP09: 9 tests; $11.94
ATP10: 10 tests; $11.94
ATP11: 11 tests; $12.14
ATP12: 12 tests; $12.41
ATP16: 13-16 tests; $14.53
ATP18: 17-18 tests; $14.63
ATP19: 19 tests; $15.21
ATP20: 20 tests; $15.69
ATP21: 21 tests; $16.19
ATP22: 22 tests; $16.68
ATP23: 23 tests; $16.68

Important: You shouldn’t report these ATP codes. When you report panels or individual codes that include tests from the list of 22, Medicare disaggregates the panel, counts up the number of tests from the automated list, and pays accordingly. If the panel includes any tests not on the list of 22 (such as non-automated tests), those are separately paid at the CLFS rate.

For instance: If your lab performs all the tests in the comprehensive metabolic panel (80053) except carbon dioxide, you should not bill 80053, which would pay $14.53 (CLFS, 2013 national limit amount). Instead, you should report the separate CPT codes for each of the 13 tests (82040, 82247, 82310, 82435, 82565, 82947, 84075, 84132, 84155, 84295, 84460, 84450, 84520), and you’d get paid at the ATP16 rate (13-16 tests) of $14.53.