Article ID Number: A56473 Status: A-Approved
Article Title: Billing and Coding: Laboratory Panels
Original Article Effective Date:
Revision Effective Date:
Basic correct coding instructs that providers will report the Healthcare Common Procedure Code System (HCPCS) and/or Current Procedural Terminology (CPT) code that describes the procedure/service rendered to the greatest specificity as possible. Multiple HCPCS/CPT codes shall not be reported if there is a single HCPCS/CPT code that describes the service. Reporting multiple HCPCS/CPT codes when there is a single code that describes the service is considered unbundling and is inappropriate coding.
The Current Procedural Terminology (CPT) Manual defines organ and disease specific panels of laboratory tests. Organ or Disease – Oriented Panels are represented by CPT codes 80047 through 80076. Each CPT code includes a list of the defined components that are included in the specific panel.
Consistent with National Correct Coding Initiative (NCCI) Edits when a laboratory performs all of the tests included in one of the panel CPT codes they shall report the CPT code for the panel. In these instances it is not appropriate to report the individual tests. For example, when a physician orders cholesterol, triglycerides, and HDL cholesterol the service shall be reported as a lipid panel with CPT code 80061.
Claims submitted with individual lab tests that are part of a specific panel will be returned to the provider as unprocessable. For example a one day (from/thru dates equal) professional claim reporting CPT codes 82330, 82374, 82435, 82565, 82947, 84132, 84295 and 84520 will be returned to the provider because the individual tests are included in a basic metabolic panel (calcium, ionized) and should have been reported with CPT code 80047.
Providers should refer to the NCCI Policy Manual Chapter 1, Section N – Laboratory Panel and Chapter 10, Section C – Organ or Disease Oriented Panels for complete billing and coding information.