Wiki CPT 80053 DENIAL

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ndanh01

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Hello,
Some help please. I recently started getting denials from Medicare for CPT 80053 (CMP). They are denying for frequency of use in a certain time frame
The billers will choose the code that
incompasses all the tests that fall within the panel and remove the others. This seems to be a frequency issue on the 80053 or modifier needed? Has there been some kind of change? Please advise.
 
ndanh01 said:
Hello,
Some help please. I recently started getting denials from Medicare for CPT 80053 (CMP). They are denying for frequency of use in a certain time frame
The billers will choose the code that
incompasses all the tests that fall within the panel and remove the others. This seems to be a frequency issue on the 80053 or modifier needed? Has there been some kind of change? Please advise.
Click to expand...
Any updates on this? Is there supporting data for frequency of lab billing?
 
Hello Ndanh01,
What is a comprehensive metabolic panel? CPT 80053
  • A comprehensive metabolic panel blood test (CMP) is a group of 14 blood tests that are performed in order to give an overview of the metabolic status of a patient. The things that are measured in this test include proteins, electrolytes, liver and kidney function tests, glucose, and calcium. A comprehensive metabolic panel (CMP) is a blood sample test that measures 14 different substances in your blood. It provides important information about your body's chemical balance and metabolism (how your body transforms the food you eat into energy). Now this is written your provider should be telling you what chronic or new problem he or she feels the patient suffers with such as dx E11, R79, E03,N18, E78, N28, I25, K76, I10 dx codes. Was the blood test order after medical treatment given? We use the dx codes listed after treated and have access to review order to help code lab test. If you can look at lab results this may help you code it too. Or use dx Z01.89 or Z13.89 or other encounter Z dx code. I hope this data helps you.
  • Lady T :)
 
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