Pathology/Lab Coding Alert

Question: We recently billed an obstetrics panel for a patient on Medicare disability. Our carrier denied the charge. What could be the cause of the denial, and how can we avoid it?

Oregon Subscriber

Answer: You are correct that Medicare denies payment for 80055 (Obstetric panel). The clinical laboratory fee schedule (CLFS) shows no payment amount for this code.

Here's why: The OB panel must include the following tests:

• Blood count, complete (CBC), automated and automated [or manual] differential WBC count (85025 or 85027with 85004, OR 85027 with 85007 or 85009

• Hepatitis B surface antigen (HBsAg) (87340)

• Antibody, rubella (86762)

• Syphilis test, qualitative (e.g., VDRL, RPR, ART) (86592)

• Antibody screen, RBC, each serum technique (86850)

• Blood typing, ABO (86900)

• Blood typing, Rh (D) (86901)

Because the CLFS has no payment amount for one component of this panel -- 86850 -- CMS also omits the entire panel.

Do this: If your lab performs the obstetrics panel tests for a Medicare beneficiary, you should bill for the individual tests. Check with your Carrier/MAC for any local coverage rules that would direct you otherwise.