Pathology/Lab Coding Alert
Check for 'Repeat' or 'Bundle' Modifiers
Question: A physician ordered basic metabolic panel 80048 for a patient, and later in the same day, ordered an ionized calcium test. Do we need a modifier for the second calcium test, and if so, which one?
Codify Subscriber
Answer: No, you should not need to use a modifier to report these two tests together for the same patient on the same day. Bill the metabolic panel with the code you listed: 80048 (Basic metabolic panel [Calcium, total]). You should also separately bill the later test for ionized calcium using 82330 (Calcium; ionized).
Because the first test measures total calcium and the second test measures ionized (free) calcium, you shouldn’t use modifier 91 (Repeat clinical diagnostic laboratory test). Clinicians may order both tests because they can provide different diagnostic information, especially in conditions such as chronic renal failure or multiple myeloma.
If you look at Correct Coding Initiative (CCI) edits, you’ll see that no restriction applies to reporting together an ionized calcium test (82330) and a total calcium test (82310, Calcium; total). This is significant, because the panel test 80048 includes the total calcium test, 82310. Because CCI doesn’t bundle the tests, you don’t need to append an appropriate modifier such as 59 (Distinct procedural service) or other appropriate modifier to report the two different calcium tests together.
Pathology/Lab Coding Alert
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