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Old 02-04-2013, 12:18 PM
bchavez7 bchavez7 is offline
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I work for an insurance company and they are currently paying for CPT code 80076 and 80050. 80076 has components that are within 80053 which is part of 80050. We follow CMS guidelines and CCI does not bundle 80050 and 80076 but does bundle 80053 and 80076. Can someone tell me if they have any guidelines statinf 80076 is inclusive to 80050.
thanks for your help!
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Old 02-08-2013, 10:06 PM
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Found this online in regards to what tests are included in certain panels. You mentioned "currently paying for CPT code 80076 and 80050" I can see that this would be correct because neither of these panels have the same tests within being performed.

You also mentioned, "80076 has components that are within 80053 which is part of 80050." This is incorrect. 80076 does have many of the same tests in 80053 which is why only the reimbursement for 80053 will be paid and 80076 will be denied. The note below the 80076 below says that reimbursement will not exceeed the 80053 since its the larger panel of tests between the two.

Finally, "We follow CMS guidelines and CCI does not bundle 80050 and 80076 but does bundle 80053 and 80076. Can someone tell me if they have any guidelines statinf 80076 is inclusive to 80050?" CCI is correct not to bundle 80050 and 80076 because the tests are completely unique in each panel and do not duplicate. As mentioned above before teh 80076 and 80050 would not be inclusive as they are two seperate panels with no duplicating tests within. I added the CPT below the test names to show a quick reference as to see duplicated tests more clearly. Hopefully this "cheat of labs" will help you determine proper reimbursement.

80053 - Comprehensive Metabolic Panel (CPT: 80053) 3mL Serum
Includes: (14 tests)
• Urea Nitrogen, Blood (BUN)(84520)
• Protein, Total (84155) except by refractometry; serum
• Potassium, Serum(84132)
• SGOT (AST)(84450) – Transferase, aspirate amino
• Bilirubin, Total (82247)
• Chloride, Serum, blood(82435)
• CO2 (bicarbonate)(82374) Carbon Dioxide
• Creatinine, Serum, blood (82565)
• Alkaline Phosphatase (84075)
• ALT (SGPT) (84460) – Transferase, alanine amino)
• Calcium, Total (82310)
• Glucose, Fasting, Quantitive (82947)
• Sodium, Serum (84295)
• Albumin; serum (82040)

Note: If both codes 80048 (basic metabolic panel) and 80053 (comprehensive metabolic panel) are billed by the same provider for the same recipient and date of service, reimbursement will not exceed payment for the comprehensive metabolic panel.

80050 – General Health Panel (CPT: 80050) 3mL Serum
Includes: (2 tests)
• CBC (Complete Blood Count) (85025)
• TSH, Ultra Sensitive – Thyroid Stimulating Hormone(84443)

80076 - Hepatic Function Panel (CPT:80076) 2mL Serum
Includes: (7 tests)
• Bilirubin, Direct (82248)
• Protein, Total-except by refractometry; serum (84155)
• SGOT (AST)(84450) – Transferase, aspirate amino
• Bilirubin, Total (82247)
• Alkaline Phosphatase (84075)
• ALT (SGPT) (84460) – Transferase, alanine amino
• Albumin; serum (82040)

Note: If both codes 80076 (hepatic function panel) and 80053 (comprehensive metabolic panel) are billed by the same provider for the same recipient and date of service, reimbursement will not exceed payment for the comprehensive metabolic panel.
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Old 02-12-2013, 10:05 AM
bchavez7 bchavez7 is offline
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Yes but per CPT 80050 includes a CBC-85025 and TSH-84443 as well as panel 80053, therefore 80076 should not be billed with lab panel 80050 as it has 80053 within it...correct?
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Old 02-12-2013, 11:04 AM
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Correct. You would not bill CPT 80076, if you are billing 80053 and 80050.
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