Wiki Denial for 84443 80053 85025

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jhaleycoder

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Iam receiving a denial from Harvard Pilgrim in MASS; Proc code/modifier invalid on DOS For codes:

84443 DX: 414.9 401.9
80053
85025

When the rep called the insurance company said these codes were bundled. According to CCI edits they are not. Can anyone please help me out.

Thanks
 
general health panel

I am sure they are wanting you to bill this as a general health panel (80050) which includes these 3 labs.
 
jhaleycoder said:
Iam receiving a denial from Harvard Pilgrim in MASS; Proc code/modifier invalid on DOS For codes:

84443 DX: 414.9 401.9
80053
85025

When the rep called the insurance company said these codes were bundled. According to CCI edits they are not. Can anyone please help me out.

Thanks
Click to expand...

Yes, you have un-bundled 80050. If you've billed this before without any problems (to Blue Cross, for example), what's probably happened is that they've actually paid you the allowable for 80050, over 1 or 2 of the charges, and denied the others as bundled. Some payers will rebundle them for you, and some won't. You should be aware, though, that it's considered an abusive practice to unbundle codes (or, to bill all of the components separately, when there's a comprehensive code that describes all of them together) - so try to avoid it.

All of the codes that start with 800XX are panels (bundle codes). I recommend making yourself familiar with them, so you can get an idea of when to use them, and what to bill with them. 80050 has a TON of codes bundled into it, because it's a combination of several panels and other labs. If you're going to bill all of the codes that make up a panel, bill the panel.
 
I made this for my office...

This finally motivated me to put it in Excel :D

This chart shows all of the main codes that make up 80050 - (well, almost...) it's not all-inclusive - it doesn't take into account other codes that might be bundled-by-association (like 85027, for example) - but it lists out all of the codes in the panels that make up 80053. It's pretty self-explanatory, but if you can't figure it out, just ask me...

This is really handy when doing follow-up, for when you've got a huge list of labs billed, and codes from these bundles are billed and denied.
 

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85025, 80053 is consider general health panel ?

My doctor ordered CBC and CMP, do I bill as a general health panel code 80050 or individual codes? Please help
 
85025, 80053 is consider general health panel ?

Answer to this is no - unless each individual lab that makes up a panel is done this is not a panel. Your two labs do not qualify as a panel.
Thanks,
Dana Chock, CPC, CCA, CANPC, CHONC, CPMA, CPB
Anesthesia, Pathology & Laboratory Coder
 
80053, 85025 and 84443

We have an in house lab and when these three tests are performed we bill an 80050 - General health panel. But we have an analyzer that is going bad on which the TSH -84443 is performed. The question is if the TSH is sent out until a new analyzer is installed would we be able to bill for the 80053 and 85027 as separate tests or would we bill the 80050 an the outside lab could bill the 84443?
 
calexander1265 said:
We have an in house lab and when these three tests are performed we bill an 80050 - General health panel. But we have an analyzer that is going bad on which the TSH -84443 is performed. The question is if the TSH is sent out until a new analyzer is installed would we be able to bill for the 80053 and 85027 as separate tests or would we bill the 80050 an the outside lab could bill the 84443?
Click to expand...

If you didn't perform all 3 tests and sent one to an outside vendor, you cannot bill the full panel. Hopefully someone will chime in on billing the 2 components and sending one the third but either way its likely to be a hassle. Why not just send the whole panel out until the machine is fixed?
 
General Health lab hiccup; 84443 going bad

Hi calexander1265, if we had that issue where I worked and had to send out a TSH 84443 - it would still be billed as a 80050 to the appropriate insurance companies. You may want to contact your AR/billing people to make sure the "added costs" of a send out are in your billing range/contract for a send out to bill a 80050 even if temporarily.
Thanks,
Dana Chock, CPC, CCA, CANPC, CHONC, CPMA, CPB
Anesthesia, Pathology, and Laboratory Coder
 
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