Pathology/Lab Coding Alert

Get ready to change how you code the basic metabolic panel with ionized calcium -- and avoid a tempting payment pitfall.

Although CMS had not finalized the 2008 clinical laboratory fee schedule (CLFS) at press time, the expected crosswalk from existing panel code 80048 to new panel code 80047 means you-d get the same pay for either panel.

That pricing could sell labs short because labs typically use separate instrumentation for the ionized calcium in addition to the seven other tests of the metabolic panel, says Katharine Ayres, MT (ASCP), CT, director of legislative and regulatory affairs for Clinical Laboratory Managers Association (CLMA).

Regardless of the pay-up, you should select the code that most accurately describes which basic metabolic panel your lab performs. Before Jan. 1, 2008, you had only one choice -- 80048. Now you have two choices:

- 80047 -- Basic metabolic panel (Calcium, ionized)

- 80048 -- Basic metabolic panel (Calcium, total).

Last year, the 80048 code definition did not specify that the test involved a total calcium reading. Although the code definition has changed, the tests included in the panel have not. Now, as last year, the 80048 panel must include the following tests: calcium (82310, Calcium; total), carbon dioxide (82374), chloride (82435), creatinine (82565), glucose (82947), potassium (84132), sodium (84295), and urea nitrogen (BUN) (84520).

In contrast, the new 80047 panel includes 82330 (Calcium; ionized) instead of 82310. All other tests in the 80047 panel are the same as 80048 (carbon dioxide, chloride, creatinine, glucose, potassium, sodium and BUN).

Do this: When reporting these services, you need to choose the code based on which basic metabolic panel the lab performs -- and that depends entirely on the particular calcium test involved (ionized versus total), says Kent Moore, manager of healthcare financing and delivery systems for the American Academy of Family Physicians in Leawood, Kan.

Impact: If the 80047 pricing crosswalks to 80048, which paid $11.83 last year, labs stand to lose money on the new panel. Medicare paid $19.09 for just 82330 in 2007 -- and ionized calcium is only one, separately performed test in the new panel. That's why some professional organizations, such as CLMA, recommended a higher crosswalk to ATP07 (Automated test panel pricing code, 7 tests) for $11.42 plus 82330 for $19.09 (total $30.51), Ayres says.

Payment for a lab panel with a unique CPT code is usually less than payment for all of the component-test CPT codes combined.

Red flag: Although the reimbursement equation might tempt labs to code the component codes rather than the panel code, you should not do so.

Instead, follow these three rules to pick the correct code(s) when your lab performs multiple tests for a patient:

1. If the group of lab tests includes all of the tests in a CPT panel, code the panel

2. If the group of lab tests includes all of the tests in a CPT panel plus additional test(s), code the panel plus separate test(s)

3. If the group of lab tests lacks one or more tests from a CPT panel, you can't code the panel -- you must list each test separately.

Lab panel loophole: These rules for panel reporting mean that sometimes labs get paid more money for fewer tests.

That's why 80047 could cost your lab money, as you can see in the following example:

Old way: Lacking a panel code, you-d report the group of 80047 tests individually for a reimbursement of $63.63 (national limit amount, 2007 CLFS).

New way: Starting Jan. 1, you-ll report the same group of tests using panel code 80047 for a possible reimbursement of $11.83 (depending on finalized 2008 CLFS).

When a patient has a condition that might interfere with the diagnostic value of the total calcium test, physicians may order ionized calcium instead.

For instance: Conditions such as kidney disease or hepatitis that can alter protein blood levels might change the total calcium reading. That's because some calcium binds to protein in the blood. But doctors really want to know the level of ionized ("free") calcium because that is the metabolically active form that impacts functions such as heart rate and muscle contraction.

Depending on what tests the physician orders, your lab should report only one panel code -- 80047 or 80048, or maybe even 80053 (Comprehensive metabolic panel), which includes additional tests such as albumin and bilirubin. CPT text notes following the three codes instruct you not to report 80047, 80048 and 80053 together.