kimberagame
Networker
Hi everyone. We have a full lab in our clinic. Our understanding of 80050 has always been that if you perform the component labs, you must bill them as 80050. The reason for the labs is irrelevant. If, say, the CBC was for anemia, the TSH was for hypothyroidism, and the CMP was for CKD, we'd bill 80050 with all three diagnoses. Similarly, if 1 or more of the labs was screening, and others were diagnostic, we'd list all reasons on the lab. This is of course only for commercial. For Medicare, we split them up. We understood billing them separately to be considered unbundling.
It's recently come to our attention that "payers typically consider 80050 to apply only when the clinician orders the general health panel specifically as a screening, so the panel code would not apply when the clinician orders the component tests for diagnostic purposes."
So now we're trying to figure out how to handle this new info. It seems if any one of the three labs gets ordered for diagnostic purposes, we should actually bill each lab individually. Is that correct? Thanks in advance!
It's recently come to our attention that "payers typically consider 80050 to apply only when the clinician orders the general health panel specifically as a screening, so the panel code would not apply when the clinician orders the component tests for diagnostic purposes."
So now we're trying to figure out how to handle this new info. It seems if any one of the three labs gets ordered for diagnostic purposes, we should actually bill each lab individually. Is that correct? Thanks in advance!