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Pathology/Lab Coding Alert

Reader Question:

Eliminate 80055 From Your Medicare Billing

Published on Tue Sep 01, 2009

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 [...]
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