Pathology/Lab Coding Alert

Question: During a second course of antibiotics for a urinary tract infection (UTI), the clinician noted abnormal findings on a basic metabolic panel, including abnormal potassium, chloride, creatinine, and blood urea nitrogen (BUN) levels. Based on concerns of kidney damage from the antibiotics, the clinician ordered a renal function panel. What are the correct diagnosis and procedure codes for this course of lab testing?

New Mexico Subscriber

Answer: The clinician will assign the appropriate diagnosis code for ordering the initial basic metabolic panel, possibly reporting a code such as N39.0 (Urinary tract infection, site not specified). Note that if the infectious agent is known, you should also report a code for the organism from the range B95-B97 (… as the cause of diseases classified elsewhere) or B37.4- (Candidiasis of other urogenital sites) for candida.

Lab test: The basic metabolic panel is 80047 (Basic metabolic panel (Calcium, ionized) This panel must include the following: Calcium, ionized (82330) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea Nitrogen (BUN) (84520)).

Based on the abnormal findings on this panel and the continued use of antibiotics, the clinician may order the renal panel with ICD-10-CM codes such as Z79.2 (Long term (current) use of antibiotics) and R79.89 (Other specified abnormal findings of blood chemistry).

Lab test: The renal function panel is 80069 (Renal function panel) This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520)).

Panel rules: The panel codes are “for coding purposes only and should not be interpreted as clinical parameters. The tests listed with each panel identify the defined components of that panel.” according to CPT^® instruction.

That means you might get an order for a group of lab tests that are either more or fewer tests than listed in a panel code. Follow these three rules to make sure you pick the correct code(s) when you perform multiple lab tests that may be included in one or more of the panel codes:

• If the group of lab tests includes all the tests in a CPT^® panel, report the panel code.
• If the group of lab tests includes all the tests in a CPT^® panel plus additional test(s), report the panel code plus separate test code(s).
• If the group of lab tests lacks one or more tests from any CPT^® panel, you should not report a panel code, but you should list each test separately.

Ellen Garver, BS, BA