Pathology/Lab Coding Alert

Question: When a physician orders a renal function panel and hepatic function panel, can I bill both codes?

Utah Subscriber

Answer: No, you should not charge for 80069 (Renal function panel) and 80076 (Hepatic function panel) for the same patient on the same day.

Here's why: The two panels include one test in common -- albumin (82040, Albumin; serum, plasma or whole blood). You should not bill two panel codes when there is overlap in the component tests required by the CPT definition. Instead, you should code the most comprehensive panel plus any additional individual tests.

CPT 2010 added the following instructional note to manage this issue: "Do not report two or more panel codes that include any of the same constituent tests performed from the same patient collection. If a group of tests overlaps two or more panels, report the panel that incorporates the greater number of tests to fulfill the code definition and report the remaining tests using individual test codes."

The comprehensive metabolic panel (80053, Comprehensive metabolic panel) includes most of the tests involved in 80069 and 80076. Further, the 80053 panel does not include any extra tests that 80069 and 80076 do not require.

Do this: Instead of reporting 80069 plus 80046, your lab should report 80053, because this is "the panel that incorporates the greater number of tests to fulfill the code definition." Additionally, you should report the two other tests that 80053 does not include:

• 84100 (Phosphorus, inorganic [phosphate]), which is part of the 80069 renal function panel, and 82248 (Bilirubin; direct), which is part of the 80076 hepatic function panel.

Remember: Panels are a coding construct, not a grouping for medical prescription. In other words, physicians may order any grouping of chemistry tests, and you should "bundle" them, for coding purposes, according to the most comprehensive panel available, plus additional tests.