Pathology/Lab Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: When a physician requests a serum albumin/globulin ratio, should we report both 84155 for total protein and CPT 84165 for the albumin fraction? I've been told that 84165 includes total protein because it is an indented code. Maryland Subscriber Answer: Contrary to the implication of your question, the common method for determining serum albumin/ globulin ratio is to assess total protein and serum albumin, then calculate the ratio. The total protein determination is reported as 84155 (Protein; total, except refractometry), and the albumin as 82040 (Albumin; serum). Because serum protein is composed primarily of albumin and globulins, the globulin fraction can be estimated by subtraction (total protein albumin = globulin). Do not report the calculation separately. Code 84165 (Protein; electrophoretic fractionation and quantitation) describes the quantitative determination of protein fractions such as albumin and gammaglobulins in serum by a method such as agarose electrophoresis. Although 84165 is indented from 84155, the only common portion of the code that precedes the semicolon is "Protein." Therefore both codes describe protein tests, with 84155 used for total protein, and 84165 used for protein fractionation and quantitation. Although the results of protein electrophoretic fractionation and quantitation provide the percentage of total protein for each fraction, labs cannot determine the quantity of each fraction in grams per deciliter without also running a total protein (84155). Labs may bill for both codes if they have provided both services.