Pathology/Lab Coding Alert

Question: Our lab often performs a 24-hour quantitative urine protein test in addition to the comprehensive metabolic panel on the same date of service. Because the metabolic panel includes a serum protein, we can't get paid for the urine protein because payers consider it "bundled" with the panel. Is there a way to get paid for the urine protein, since it is, in fact, a separate test?  

Missouri Subscriber

Answer: You are correct that payers consider the total protein (84155) bundled with the comprehensive metabolic panel (80053), because 84155 is one of the listed tests that define the panel components. Until the 2004 CPT code changes, you had to use modifier -59 (Distinct procedural service) to get paid for the total urine protein (84155, Protein; total, except refractometry) if you billed it in addition to the 80053 (Comprehensive metabolic panel) performed on serum.
 
CPT 2004 removes the bundling problem for a comprehensive metabolic panel and a urine protein. The difficulty arose because 84155 for total protein did not specify the source. In your example, the lab performed an 84155 on serum as part of the 80053 panel and a separate 84155 on urine. Because CPT 2004 provides three source-specific codes for total protein by refractometry, this coding dilemma goes away.
 
Given the same lab scenario, you would now code it as follows under CPT 2004: Report 80053 for the comprehensive metabolic panel. This includes the serum protein as one of the tests - 84155, which CPT 2004 gives a revised definition (Protein, total, except by refractometry; serum). For the urine protein, you should now report new code 84156 (... urine). Because the comprehensive metabolic panel doesn't include 84156, you should have no problem reporting urine protein on the same day as 80053.