Lab Billing - right procedure code

mhicks00

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Local Chapter Officer
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La Porte, Indiana
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I am trying to find out if there is anything against changing a procedure code from what the doctor ordered. The example that I have is A doctor will order a PSA (84153) with a diagnosis of V76.44. For Medicare the right procedure code is G0103. When we see the 84153 is ordered we change it to the G0103. Another example is the General Health Panel a doctor will order all three tests (84443,80053,85025) certain insurance companies what these test bundled so we change this to the procedure code 80050.

Does the ordered procedure code from the doctor have to match what we bill in these examples? I have been told that we have to ask the doctor to change the coding on these examples and I would like to verify this because we are still performing the test that was ordered.

Thanks for the help
 

saeedakhtar

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Lab billing

You should not change the codes untill you ask the doctor and explain to him the demand of insurance company.
 

mitchellde

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Columbia, MO
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You have not changed the procedure just the code that represents that procedure so you are OK to do so. The three tests you change to the 80050; if these three tests are what makes up the 80050 then you should do this always for everyone, you cannot split out the components of a panel for separate billing, however if the 80050 contains other tests as well then you cannot do this.
 

calexander1265

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Raliegh North Carolina
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I agree with Debra, you are not changing a procedure, you are billing it in accordance with the payors directives and the codes that make up a panel test should be billed together as the panel code. Separately billing the codes is considered unbundling.
 

mhicks00

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Local Chapter Officer
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La Porte, Indiana
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the codes 84443,85025,80053 bundle into the 80050. Some insurance companies require it bundled and some, like Medicare will not pay for it bundled. There are no other codes that go into this code, but the doctor orders this as a unbundled test and the coders bundle it when needed by the insurance company.
 
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