Pathology/Lab Coding Alert

Question: Weve been billing for the new basic metabolic panel (ionized calcium) code and have seen our reimbursement for the test drop dramatically. Whats going on?

Indiana Subscriber

Answer: The test youre referring to is 80047 (Basic metabolic panel [Calcium, ionized]). CPT 2008 added 80047 to describe a panel distinct from 80048 (Basic metabolic panel [Calcium, total]). The two panels include all of the same tests, except 80047 includes 82330 (Calcium; ionized) while 80047 includes 82310 (Calcium; total).

Because 82330 was not on Medicares test list for automated multichannel chemistry (AMCC), CMS originally priced 80047 as a seven-test panel plus the individual price for a separate ionized calcium test (approximately $30). In July 2008, however, CMS added 82330 to the AMCC list and re-determined pricing for 80047 as an eight-test automated panel. That lowered payment to approximately $12 -- the same as 80048.

Many laboratory professional societies have spoken out against the change, because laboratory auto-analyzers do not include an ionized calcium test (except for a point-of-care instrument from one manufacturer). Labs must perform a separate ionized calcium test on a different instrument, but Medicare pays for the service as though the lab performs a single automated chemistry panel.

-- Reader Questions and You Be the Coder were prepared with the assistance of R.M. Stainton Jr., MD, president of DoctorsAnatomic Pathology Services in Jonesboro, Ark.