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Wiki HELP!!! Unbundling Labs?

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nmanis

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Ashtabula, OH
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Okay, so a general health panel 80050 includes: 84443 (TSH) ,85025 (CBC) and 80053 (CMP).

Is there ever a circumstance you can bill the three codes seperately? I have educated my physicians that if multiple labs billed roll up to a panel, you must bill the panel. The catch? 80050 is not covered by Medicare because it is considered a preventative service and the reimbursement is about 25% of what you receive when the codes are billed seperately! Now, I'm in Ohio and we have located an article stating that Ohio state law dictates when the components of a panel are billed then you must bill a panel.

Help! This is very important to our practice! If any of you have any experience in this area I would greatly appreciate it!:confused:
 
A general health panel would be for a preventative visit. You would request it to get the general health of the patient. Not because of a diagnosis of something. If you need a TSH for a patient there is probably going to be a reason or diagnosis related to that for that particular test.
 
Any time all components of a panel are done, they are always billed as a panel, not separately. Billing separately could be seen as fraudulent billing since you are unbundling to get paid.
Pam, CPC, CPC-P
 
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