Wiki 80050 vs unbundling

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Babsss

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Local Chapter Officer
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Anniston, AL
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We are having problems with getting cmp and cbc labs paid when coded separately, so we tried to bundle them with 80050. These are not paying either. Does anyone have an answer for this. I am really frustrated and I see someone also asked the question round about. Thanks for any help anyone can give me.:cool:
 
80050

You cannot code 80050 unless all three elements are performed including the TSH. For commercial if all three are performed, you must bill the 80050 and cannot unbundle. Medicare will not pay 80050, so you would have to bill each test separately. Perhaps it is the Diagnosis codes that you are using. Also, if it is Medicare and you are not a lab, you cannot do pass through billing so you would only be able to bill for clia waived tests, unless your office is certified as a lab and performs them there. If you send them out to a lab, that lab would have to bill the services.
 
Thank you for the response. I am understanding this better. Our two clinics do have a full lab.
 
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