Pathology/Lab Coding Alert

Question: The lab performs a basic metabolic panel, and later in the same day the physician orders a blood glucose test for the same patient because of an abnormal initial reading. How should we code the service?

Tennessee Subscriber

Answer: You should bill the panel as 80048 (Basic metabolic panel). The panel includes calcium (82310), carbon dioxide (82374), chloride (82435), creatinine (82565), glucose (82947), potassium (84132), sodium (84295), and urea nitrogen (BUN) (84520).
 
Because the panel includes glucose, payers will deny your bill for 82947 (Glucose; quantitative, blood [except reagent strip]).
 
Do this: Use modifier 91 (Repeat clinical diagnostic laboratory test) with 82947 to indicate that this is not a duplicate bill, but a separate test repeated on the same day.
 
Red flag: You should use modifier 91 only when repeating a laboratory test that is medically necessary in the course of patient treatment. The ordering physician should establish the medical necessity. Do not use 91 if the lab runs the test again for the following reasons:

 - to confirm initial results
 - because of testing problems related to specimens or equipment
 - for any other reason when a normal, one-time reportable result is all that the physician needs for appropriate patient treatment.