80050 - handle this situation


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From a payer's point of view how would you handle this situation? A lab bills for 80053, 84443 and 85025 as separate components. The payer denies the claim because they say it should be billed as a panel 80050. The lab states Medicare rules and fee schedule and cannot rebill as a panel. Is it possible for the payor to edit the claim and pay it as a panel?
Call them, then write an appeal letter

What the billers in my company does is send out an appeal stating why you first billed the codes used (such as the reasoning). Then describe that the panel is the best option to choose, Medicare is super fussy with EVERYTHING so first I would call someone. If Medicare paid 2 out of 3 procedures billed see if you can refund the money and then rebill with the new code. You probably will have to send out doctors notes with your appeal letter because they must know you have reason behind the code change.

Not sure about editing the claim, but if you bill 85025, 84443 & 80053 you are unbundling them. The panel 80050 includes them all.
Good luck:)