Wiki Billing For Labs...help!!

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JCampbell

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OUR OFFICE BILLED THE FOLLOWING CPT CODES FOR LABS THAT WERE DONE IN OUR OFFICE: 36415, 85025, 80061, 81000, 80050 AND 80076.

I HAVE ONE QUESTION:

1. THE INSURANCE COMPANY IS CHANGING CPT CODE 80076 TO 82248 AND IS REIMBURSING US FOR THE CODE THAT THEY CHANGED IT TO. CAN ANYONE TELL ME WHY THEY WOULD CHANGE THE CODE?
I CALLED THE INSURANCE COMPANY AND THEY TOLD ME THAT THEIR EDITING SYSTEM CHANGED IT. I LOOKED IN THE CPT BOOK AND I'M REALLY NOT UNDERSTANDING WHY IT WAS CHANGED.:confused:

ANY HELP WOULD BE GREATLY APPRECIATED.
THANKS!!
 
I would know whay they did that either cause the 80076 is a panel and the 82248 that they changed it to is one of the codes that is in the 80076 panel. I think the person that is going to be able to answer this question is ithe insurance company and you can always appeal the claim.

Jessica Harrell, CPC
 
The panel 80050 includes a CMP (80053) which includes all the tests in 80076 except 82248. So the insurance carrier unbundled the test and paid how they thought was appropriate.

Hope that helps
NCooper
 
All the tests in 80076 are duplicated in 80053 with the exception of 82248. They simply unbundled all the panels and left out the duplicates and all you are left with is 82248.

G Brown
 
So...if the insurance wants to bundle CPT 80076 into CPT 80053, they should reimburse seperatly for CPT 82248? Thanks!

Paula CPC,CPMA
 
Another question regarding labs that are drawn in the office. We were using modifier 26 on each lab code. Is this appropriate? I don't think it is, but now that I am reading all of the responses in this forum, I see what may be happening to our claims. Should the office be using modifier 26 on these lab codes?
R
 
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