Pathology/Lab Coding Alert

Question: Should a laboratory bill for a panel if not all of the tests are done, but the cost of the individual tests is greater than the cost of the panel? For example, if a physician orders all tests in the comprehensive metabolic panel (80053) except alanine amino transferase, aspartate amino transferase, and urea nitrogen, should 80053 be reported if the reimbursement for the panel is less than the reimbursement for the 11 individual tests? How should the scenario be coded if, in addition to 11 of the 14 tests on the comprehensive metabolic panel, the lab also performs two other tests that are not part of the panel? Should the lab bill the panel plus the two non-panel tests, or bill each one separately?

Virginia Subscriber

 
Answer: Report the codes for the exact services provided. If every test in a panel is not carried out, do not report the panel code, but the individual codes for those tests.
 
In the example given, rather than reporting 80053 for the comprehensive metabolic panel, the lab would report 82040 (Albumin; serum), 82247 (Bilirubin; total), 82310 (Calcium; total), 82374 (Carbon dioxide [bicarbonate]), 82435 (Chloride; blood), 82565 (Creatinine; blood), 82947 (Glucose, quantitative, blood [except reagent strip]), 84075 (Phosphatase, alkaline), 84132 (Potassium; serum), 84155 (Protein; total, except refractometry), and 84295 (Sodium; serum). If two additional tests were performed, those would be reported with their appropriate CPT codes as well. Instructions for the organ or disease oriented panels section of CPT state, If one performs tests in addition to those specifically indicated for a particular panel, those tests should be reported separately in addition to the panel code.

CPT codes serve many functions, only one of which is reimbursement. The codes also provide a uniform language that will accurately describe medical, surgical and diagnostic services, and will thereby provide an effective means for reliable nationwide communication among physicians, patients, and third parties, the AMA says. Therefore, reporting a panel code when the entire panel of tests is not carried out provides misinformation in the medical record regarding a patients condition, and skews any statistical information about frequency of testing, etc.