Tips to Avoid Issues When Bundling Lab Test Codes
Clinical labs handle diverse diagnostic categories, from serology to histopathology and beyond. Billing lab codes can be straightforward, but mixing codes increases denial risk.
What is ‘Panel’?
Packaging a series of akin lab tests into one comprehensive lab test is called as a panel or lab profile. Bundling tests for comprehensive diagnosis and treatment.
Three terms that billers need to be familiar with, when dealing with Laboratory codes:
- Comprehensive Code – that defines a panel of bundled set of tests and their codes
- Component Codes – Defining bundled tests for comprehensive codes.
- Custom Panels – that defines a set of tests in a panel that are customized by the laboratory to their liking.
Billed individually or by CMS-defined codes. So, they can be billed as bundled. Lab panels aim to identify a singular prognosis.
Some Common Chemistry Panels are as follows:
- Basic Metabolic Panel (BMP) – Tests for blood sugar, electrolytes, kidney, respiratory, & liver function.
- Comprehensive Metabolic Panel (CMP) – Includes BMP data, liver status, and blood proteins.
- Electrolyte Panel – for detecting a problem with the body’s fluid & electrolyte balance.
- Lipid Profile – to assess the risk of developing cardiovascular disease.
- Hepatic Function Panel or Liver Panel – Screens for liver inflammation, disease, and damage.
- Renal Panel or Kidney Function Panel – Kidney function evaluation.
- Thyroid Function Panel – to assess thyroid gland function and help diagnose thyroid disorders.
For example
Physicians order BMP/CMP to assess overall health.
Basic metabolic panel is part of comprehensive metabolic panel. Meaning, its tests are already bundled into the comprehensive panel. CMP supersedes BMP and its components.
What are guidelines for billing panel codes?
CMS policies prohibit unbundling lab panel codes.
- Individual component lab tests are not to be repeated or duplicated.
- CMS will not pay for the panel code unless all of the tests in the definition are performed.
- Custom panels bill additional tests separately.
- Lab can bill individual tests, but payment follows rules.
- Bill HCPCS panel code, not individual tests.
- Report panel with most tests, remaining tests individually.
- Claims will be returned as processable/rejected if the HCPCS panel test code is not billed.
- Payment for the total panel may not exceed the sum total of the fee amounts for individual covered tests.
This billing policy applies when:
a). Submitting a complete organ disease panel; or
b). Unbundling individual tests without complete panel.
CMS table: Bundled component codes.
Tests Performed More Than Once on the Same Day?
However, repeat tests may be medically necessary. Bundling and repeated lab tests.
Modifiers indicate medically necessary repeats.
Modifier 91: Repeated tests for multiple results.
Modifier 59: Distinct procedural service.
Let’s have a look how CMS guides us about their use:
Proper Use | Improper Use |
|---|---|
These Modifiers for repeated tests. | Modifiers exclude confirmatory tests. |
Modifier 91 for repeated labs, 59 for distinct labs. | These modifiers may not be used when there are standard HCPCS codes available that describe the series of results (e.g., glucose tolerance tests, evocative/suppression testing, etc.). |
These Modifiers for clinical lab fee schedule. |
|
Final say?
Modifiers 59/91 for multiple results. Excessive modifier use triggers review.
It would also be greatly helpful if Laboratories documented verbal orders for tests. The date the service was performed should be stated in the patient’s record. Labs review patient records.
AltuMED PracticeFit enables Medical Billers with an inbuilt scrubber feature, reducing the chances of coding errors to 92%. Schedule a PracticeFit demo to know more:
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