Pathology/Lab Coding Alert

Question: Our physician-office lab uses the Abaxis xpress blood chemistry analyzer and often performs a specific group of tests that are not a CPT -panel.- We-ve had problems with payment for some of the tests, such as the uric acid test. Do you have any recommendations?

Ohio Subscriber

Answer: Both the Abaxis xpress and Piccolo Blood Chemistry Analyzer can provide quantitative evaluation of alanine aminotransferase (ALT), albumin, alkaline phosphatase (ALP), amylase, aspartate aminotransferase (AST), calcium, creatinine, gamma glutamyltransferase (GGT), glucose, total bilirubin, total protein, blood urea nitrogen (BUN), and uric acid in whole blood.When you perform a group of tests that does not conform to a CPT -panel- such as the renal function panel (80069), you should code the tests individually.

For instance: If the physician orders ALP, total protein and uric acid, you should report 84075 (Phosphatase, alkaline), 84157 (Protein, total, except by refractometry; other source [e.g., synovial fluid, cerebrospinal fluid]), and 84550 (Uric acid; blood).

CLIA may be problem: If you-re a laboratory that operates under a CLIA certificate of waiver, your CLIA status might explain why you haven't been paid for tests such as uric acid. According to Change Request 6060, effective July 1, 2008, -The new waived CPT/HCPCS code, 84550QW has been assigned for the uric acid test performed using the - Abaxis Piccolo xpress Chemistry Analyzer (General Chemistry 13 Panel) (Whole Blood).- Prior to that date, you wouldn't get paid if you billed 84550 for the test.

Don't miss: If you are a CLIA-waived lab, you should report each of the codes -- 84075, 84157, and 84550 in your example -- with modifier QW (CLIA waived test) to show that you rightfully can perform and bill for the test.