Wiki Micorobilology Lab denial

[Mad0824]

We received the following denial "“Not supported. There is a more appropriate lab panel CPT code that should be billed when one or more CPT codes are included in the same panel”. Codes billed included 87480,87510,87660,87491,and 87591, Does anyone know what "panel" they would be referring to. We are not aware of any microbiology panel codes. Wondering if perhaps it is just an incorrect denial.

 

[antoniamay]

I assume they are talking about 87800 and 87801. Which in this case it would look like you need to bill both because some are direct probe and some are amplified probe techniques.

 

[mmiele1979]

We received the following denial "“Not supported. There is a more appropriate lab panel CPT code that should be billed when one or more CPT codes are included in the same panel”. Codes billed included 87480,87510,87660,87491,and 87591, Does anyone know what "panel" they would be referring to. We are not aware of any microbiology panel codes. Wondering if perhaps it is just an incorrect denial.

Was this from UHC?? We are having the same issue. We don't run panel tests - they are all individual labs with individual specimens. I see nowhere in any guideline that states that even if we are running separate tests, we must bill a panel code. In fact, CPT guidelines literally state (in our case) that the panel code is for a "single procedure, multiple results" - which is not what we are doing. We are currently fighting this. What happened in your scenario?

 

[JulianneG39]

We received the following denial "“Not supported. There is a more appropriate lab panel CPT code that should be billed when one or more CPT codes are included in the same panel”. Codes billed included 87480,87510,87660,87491,and 87591, Does anyone know what "panel" they would be referring to. We are not aware of any microbiology panel codes. Wondering if perhaps it is just an incorrect denial.

I would assume they mean CPT 81513 or 81514. It is a panel for amplified probe and direct probe technique for bacterial vaginosis with the various organisms tested.

 

[mmiele1979]

If you aren't running a panel, you shouldn't be billing a panel. A panel is defined by CMS as a single procedure with multiple results. One specimen. This is also defined in the CPT book. In addition, UHC laboratory and Microbiology policy doesn't state anywhere that you must bill a panel code if you are running individual labs. Their microbiology policy references genetic testing. Their laboratory policy talks about Organ panel codes. This is a stunt UHC is pulling. APPEAL, ask for a peer review. My office is experiencing the same issue. I will not be changing my codes.