Can the lab choose which panel to bill 80047 + Ca, total or 80048 +Ca, ionized?

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lcclark75

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I was asked an interesting question today and I'm not confident that I have the correct answer.

The question from lab was as follows:

"If we perform all of the tests for the 80047 and 80048 does it matter if we bill for 80047 + Total Ca or 80048 + iCa? Are we allowed to choose which one we bill?"

80047– Must include these tests: Calcium, ionized (82330), Carbon dioxide (82374), Chloride (82435), Creatinine (82565), Glucose (82947), Potassium (84132), Sodium (84295), and Urea Nitrogen (BUN) (84520)

80048 – Must include these tests: Calcium, total (82310), Carbon dioxide (82374), Chloride (82435), Creatinine (82565), Glucose (82947), Potassium (84132), Sodium (84295), Urea Nitrogen (BUN) (84520)

This is more of a billing question than coding question, but I just want to give the proper answer. My gut says "you bill the combination that is the least cost to the payers", but I need to find that in writing. :)
 
Hello and Good Evening lcclark75
Absolutely not, you may not choose the one you want to bill. There are CCI edits in place to tell you which CPT is comprehensive, and which one isn't.
I ran this through CCI (correct coding initiative) and you may only bill 80047 here for this date if both procedures were performed on the same date of service. No modifier is allowed.
I'm a little concerned that your gut answer is "you bill the combination that is the least cost to payers". This may be a learning curve here, but you would not send a charge with reduced fees.
80047 has more RVUs versus 80048. The healthcare facility you work for is expecting RVUs and we want to follow all coding guidelines and provide every RVU deserved to them.
I am seriously clearly not trying to be disrespectful or rude in any manner but just understand it through someone else's eyes please. Sometimes receiving this intel provides me insight on how to be a better educator.
I hope you have a fantastic evening; I am also very hopeful you respond and not delete this post. There are possibly other coders in your shoes that may have this same experience and would appreciate answers.
That is why I responded.
Dana
 
danachock said:
Hello and Good Evening lcclark75
Absolutely not, you may not choose the one you want to bill. There are CCI edits in place to tell you which CPT is comprehensive, and which one isn't.
I ran this through CCI (correct coding initiative) and you may only bill 80047 here for this date if both procedures were performed on the same date of service. No modifier is allowed.
I'm a little concerned that your gut answer is "you bill the combination that is the least cost to payers". This may be a learning curve here, but you would not send a charge with reduced fees.
80047 has more RVUs versus 80048. The healthcare facility you work for is expecting RVUs and we want to follow all coding guidelines and provide every RVU deserved to them.
I am seriously clearly not trying to be disrespectful or rude in any manner but just understand it through someone else's eyes please. Sometimes receiving this intel provides me insight on how to be a better educator.
I hope you have a fantastic evening; I am also very hopeful you respond and not delete this post. There are possibly other coders in your shoes that may have this same experience and would appreciate answers.
That is why I responded.
Dana
Click to expand...
Hi Dana,
Thank you for your candid response. The question asked of me initially was based on CMS Panels that we offer. Our lab doesn't offer an 80047 as a distinct orderable. It requires 2 different samples. They were genuinely curious to find a solution for proper billing based on what we actually offer in our lab. As an example, a renal chem 10 is not a CMS panel that we offer. For billing purposes, when a chem 10 is ordered, an 80048 + Mg (83735) + Albu (82040) + Phos (84100) is billed. Is it permissible to bill this way for panels we don't offer?

Thanks for your thoughts.
Larissa
 
Hellolcclark75,
I do apologize but I don't understand. You may understand your internal conversations but from what I read 80047 isn't orderable. Clearly, unsure why not?
I clearly don't know if it is billable or not yet.
Healthcare facilities should not be "crippled" because the interface from dropping charges from Beaker, Epic or Powerpath, or Co-path or otherwise here.
Tell me what was in the Chem 10 (every CPT code provided for this very test) and I will review to see if 80048, 83735, 82040, with 84100 is billable tomorrow okay.
Thanks,
Dana
 
The renal Chem 10 includes the following: Albumin (82040), Calcium, total (82310), Carbon dioxide (bicarbonate) (82374), Chloride (82435), Creatinine (82565), Glucose (82947), Phosphorus inorganic (phosphate) (84100), Potassium (84132), Sodium (84295), and Urea nitrogen (BUN) (84520).

Since we do not have a renal chem 10 as distinct orderable, the lab is asking if we can bill for an 80048 + Mg (83735) + Albu (82040) + Phos (84100)

I also found another scenario where the lab billed a chem 10 as 80047 + Mg (83735) + Ca, total (82310) + Phos (84100) + Albu (82040)

Thank you for your help.
 
Hello lcclark75
I ran analysis on all three of your laboratory scenarios and we do not have any bundling issues here. If all the lab scenarios you described are billing those very CPT codes and are supported billing those charges.
No modifier is needed.
I do feel badly that they do not give you the resources to research this yourself or have edits in place to state when two CPT codes billed on same DOS (date of service) may require a modifier after reviewing all the necessary documentation. Having solid laboratory resources such as NCCI edits are important. Also creating "front line edits" before charges move out the door to the payor (insurance) is incredibly important.
I hope you have a fantastic evening,
Dana
 
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