asylve38
New
I think I posted in the wrong area I need to know can you bill 80053 and 85025 together on a claim with no modifiers?
-
If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below..
Wiki LABS
- Thread starter asylve38
- Start date
TThivierge
True Blue
Hi Asylve
No only bill 80050 which in bundles in the other lab of 85025. Also can check the CPT manual.
Lady T
No only bill 80050 which in bundles in the other lab of 85025. Also can check the CPT manual.
Lady T
Hi Asylve
No only bill 80050 which in bundles in the other lab of 85025. Also can check the CPT manual.
Lady T
Doesn't the thyroid stimulating hormone (84443) need to be included to make it an 80050? (I don't bill lab panels, but I see it in the definition of 80050 which I thought meant it had to be performed to bill the panel.)
lgardner
Guest
yes. the tsh 84443 must be included in 80050:
per EncoderPro -
80050 -General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Thyroid stimulating hormone (TSH) (84443)
ALSO, this is not my topic of expertise, but per EncoderPro, there are no edits between 80053 and 85025, AND I see no overlap of the tests included in each panel.
So, I might wait for a lab expert to respond, but I don't see why you couldn't bill these codes together without a modifier.
TThivierge
True Blue
Hi
If you bill the Gen Health panel lab code of 80050 the provider will have all of those labs listed in the panel tested. If the provider selects CPT 80050 panel then all these lab test will be completed. You do not bill separately if more than 1 lab test included in the panel already. As listed above by lgardner, the following lab codes mentioned above are included when selecting lab CPT panel of 80050. If you bill these both CPT 80050 & 85025 it will be considered a denial since lab code 85025 is bundled in the lab panel of CPT 80050.
Now the provider could add another 85025 lab code as extra code to bill this test 2 times if he or she likes. Then I d put a modifier 91 on CPT 85025 if bill it by itself along with the CPT 80050 panel on the claim.
Now if a provider wanted to bill one lab test like CPT 84443 only he can do this if only result he or she wants is from this lab. If provider selected a lab panel as listed above all labs would be tested .Panels usually have selection of more than 1 lab test so you choose a Lab panel code. The CPT code list a few coded panels such as: 80047 80048 80053, 80051 80050,80055, 80081, 80074 ,80076, 80061 in which most provider give a rationale of medical necessity why ordering. Included in each panel is a group of lab test but only put panel CPT code on claim
I hope this data helps you
Lady T
If you bill the Gen Health panel lab code of 80050 the provider will have all of those labs listed in the panel tested. If the provider selects CPT 80050 panel then all these lab test will be completed. You do not bill separately if more than 1 lab test included in the panel already. As listed above by lgardner, the following lab codes mentioned above are included when selecting lab CPT panel of 80050. If you bill these both CPT 80050 & 85025 it will be considered a denial since lab code 85025 is bundled in the lab panel of CPT 80050.
Now the provider could add another 85025 lab code as extra code to bill this test 2 times if he or she likes. Then I d put a modifier 91 on CPT 85025 if bill it by itself along with the CPT 80050 panel on the claim.
Now if a provider wanted to bill one lab test like CPT 84443 only he can do this if only result he or she wants is from this lab. If provider selected a lab panel as listed above all labs would be tested .Panels usually have selection of more than 1 lab test so you choose a Lab panel code. The CPT code list a few coded panels such as: 80047 80048 80053, 80051 80050,80055, 80081, 80074 ,80076, 80061 in which most provider give a rationale of medical necessity why ordering. Included in each panel is a group of lab test but only put panel CPT code on claim
I hope this data helps you
Lady T
Last edited: