Get a Firm Grasp of Organ- and Disease-oriented Panels
Be sure all ordered pathology and laboratory tests were performed, and know what’s bundled.
by M. Colleen Mescall, MHA/E, CPC, CPC-I, CPMA
As an instructor, I find that panel coding is one of the hardest concepts for new coders to grasp. Although panels create an efficient method to report tests often ordered together, they also create risk of unbundling or missing elements required to report the panel code.
Panels Bundle Many Tests into a Single Code
Each of the panel codes (80047-80076) includes multiple tests. When all of the tests included in the panel are performed, report the panel code; however, each test within the panel also has its own CPT® code. If any single test defined as part of the panel is not performed, report the code(s) to describe the individual tests performed, rather than the panel code.
… panels were developed for coding purposes only and should not be interpreted as clinical parameters. The test are listed with each panel identify the defined components of the panel. These panel components are not intended to limit the performance of other tests. If one performs tests in addition to those specifically indicated for a particular panel, those tests should be reported separately in addition to the panel code.
For example, panel code 80047 Basic metabolic panel (Calcium, ionized) includes these lab tests:
82330 Calcium; ionized
82374 Carbon dioxide (bicarbonate)
82435 Chloride; blood
82565 Creatinine; blood
82947 Glucose; quantitative, blood (except reagent strip)
84132 Potassium; serum, plasma or whole blood
84295 Sodium; serum, plasma or whole blood
84520 Urea nitrogen; quantitative
If all of these tests are performed, report the entire panel with 80047. But if any one of the included tests is not performed, report each performed test separately. It would not be appropriate to add modifier 52 Reduced services to 80047.
Look Out for Duplicative Billing and Unbundling
You cannot report two or more panel codes that include any of the same component tests. If the tests included in two panels overlap, report the panel code that includes the greater number of tests to meet the code definition.
For example, you cannot report 80051 Electrolyte panel and 80047 together. Only report 80047 because it includes all the tests in 80051 (plus a few others).
Tests Not Part of the Panel May be Separately Reported
Suppose the provider orders an electrolyte panel (80051) and also a glucose test (82947). The glucose test is not included in the panel. Rather than add modifier 22 Increased procedural service to 80051 to account for the glucose test, report both 80051 and 82947.
Bottom line: Before reporting panel codes, ensure all tests ordered for that panel were done, remember not to unbundle the panel codes, and report separately any lab test not included as part of the panel.
M. Colleen Mescall, MHA/E, CPC, CPC-I, CPMA, ICD-10 AAPC Trainer, has worked in various areas of healthcare for over 28 years, including hospitals, private practice, with the Department of Defense, as a consultant, and as a coding instructor. Mescall is a billing compliance educator for VCU Health Systems, and she is president of the Richmond, Virginia, local chapter.