BMP w/o Calcium and CBC w/o diff

rslamar

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Fairly new to all of this as the billing side is more of my forte. Our Urgent Care is expanding to do additional lab testing. They purchased a machine that can run a Basic Metabolic Panel but without Calcium (80051, 82565, 82947, 84520) and Blood Count Complete (CBC) without the differential (85027 or G0307 for Medicare) are the the codes that I gave them from my research. They came back and said that these codes DO NOT have pricing on the CMS fee schedule. After research, they are not payable on the physician fee schedule, but they are payable on the clinical lab fee schedule. Before I respond that these are payable on the clinical lab fee schedule I want to confirm that these are the codes that I should use.
Question: Do you agree with the codes I provided?
 
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sls314

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The Clinical Lab Fee Schedule is what's used for reimbursing lab tests. Those lab codes would never appear on the CMS Physician Fee Schedule, so you can definitely educate them on that.

It has been a long time since I've done labs, so I'm not going to profess to be a current expert on lab coding. However, I did briefly look at the components of the Basic Metabolic Panel w/o Calcium and at a glance it appears to me that your code choice (the electrolyte panel + Creatinine + Glucose + BUN) seems accurate to me.
 

rslamar

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Thank you so much! I was glad that I remembered that we would use the Clinical Lab Fee Schedule before you or anyone else saw that and responded haha. Happy Monday!😁
 
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