Wiki Confusion over labs included in 80050

[Rebecca Pate]

80050 includes CBC, TSH, and CMP. We have been receiving payments from BCBSGA and they are bundling the CBC and TSH to the 80050, and no CMP was done. The way I read the description of 80050, all 3 labs are needed to bundle.
Any direction would be greatly appreciated.

 

[alyssak88]

this is an example from UHC and what they will bundle as a Electrolyte Panel (80051)

Electrolyte Panel, 80051

A submission that includes 2 or more of the following laboratory component codes by the same individual physician or other health care professional for the same patient on the same date of service is a reimbursable service as an Electrolyte Panel, CPT code 80051.

80051 Electrolyte Panel
Includes two or more of the following individual component codes for the same patient on the same date of service:
.
82374
Carbon Dioxide (bicarbonate)
.
82435
Chloride; blood
.
84132
Potassium; serum, plasma or whole blood
.
84295
Sodium; serum, plasma or whole blood

I dont have anything off hand for BCBS but I wanted to show you that the Insurance companies can come up with their own definitions of what is a panel. Like the example above in the CPT book you need all four of the above tests to make up a 80051 but in the UHC reimbursment policy they say they will take any two of those tests and bundle as a 80051. The best thing to do is call and make sure that is what they did and it was not a mistake of some sort.

 

[alyssak88]

Oh and I know your question was about 80050 but this is the best example I had available!

 

[lynjones68]

80050 includes CBC, TSH, and CMP. We have been receiving payments from BCBSGA and they are bundling the CBC and TSH to the 80050, and no CMP was done. The way I read the description of 80050, all 3 labs are needed to bundle.
Any direction would be greatly appreciated.

If most of the labs in a panel are performed, they will bundle them into the panel if billed individually. That is what I have noticed. I hope this helps.