Wiki panel vs individual labs

[Michele1229]

Hello -

I was hoping someone could help me. I am trying to figure out when it is appropriate to bill for individual labs versus the panel.
Say we want to bill 84520, 82565, 84450 and 84460. Should we be billing a panel or just these individual labs?
Do you have to have a minimum number of the individual labs to consitute a panel? Meaning... say a panel has 10 codes attached to it. Do you have to perform all 10 of those to bill the panel or not? Is there a miniumum number to meet the panel requirement?

Thanks for everyones help!

 

[danachock]

Panel versus Individual Lab coding

You will bill a panel out over individual codes every time unless there is a insurance company that does not accept the panel code.
The reason I say that is if you bill out individual codes that make up a panel - you will be denied by the insurance carrier for billing out "unbundled services".
I am not 100% acclimated with EVERY panel that is billable - but to me you have a Urea Nit, AST, ALT & Creat those would be billed out individually.
A panel has a prerequisite number of specific labs that make it up. If you refer to your CPT book I will provide an example 80050 General Health panel (is made up of TSH 84443, Hemo w/Diff 85025 & Comp Met Panel 80053).
Unless all three of those labs are done on the same DOS you will not be able to bill it out as a panel. If the TSH and the Comp Met Panel are done - you are only able to bill out the individual labs. You can't bill the panel code unless all three laboratory tests are done on the same DOS.
You have to complete every lab that makes up the panel to bill out the panel code.
Thanks,
Dana Chock CPC, CCA, CANPC, CHONC
2013-2014 Brainerd AAPC Chapter President

 

[Michele1229]

So in my example... we did BUN, AST, ALT and Creatinine. My employer says we need to bill out the 80053 for the comprehensive panel since these 4 codes are in that panel. But this would be incorrect because we need to have done all the codes listed under 80053 to bill a panel. If you do not do all the labs listed under the panel then you can bill individually?

 

[danachock]

panel

No the comp met panel 80053 requires more then 4 labs to be done.
So yes you will bill those four labs individually. Please do not bill a panel code unless every lab that is listed in that panel has been done on the same DOS.

If you have edit issues - please let me know, I have battled many of them working numerous laboratory denials that have led me to request our IT department to add edits to fix errors before they go out the door versus after they have gone out the door.