Pathology/Lab Coding Alert

Question: A physician ordered an electrolyte panel for a patient, and then ordered a separate chloride test later the same day. Our payer denied the chloride test. Is there any way to get paid for both services?

California Subscriber

Answer: Yes, payers will cover an electrolyte panel and a separate chloride if you use a modifier to indicate that you've performed two distinct tests.

Problem: The electrolyte panel (80051, Electrolyte panel) includes chloride as one of its components, so billing separately for chloride (82435, Chloride; blood) sends up a red flag.

In the case you describe, however, the physician orders a distinct chloride test later in the day, presumably with a medically necessary reason to repeat the chloride portion of the panel.

Do this: Bill the chloride (82435) with modifier 91 (Repeat clinical diagnostic laboratory test) to indicate that you've repeated the test and that you aren't unbundling a charge from the original panel code. Although less common, some payers may direct you to use a different modifier, such as 59 (Distinct procedural service) or 76 (Repeat procedure or service by same physician or other qualified health care professional).