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lab question from internal medicine physician

Paula Posted Thu 14th of August, 2014 15:48:58 PM

patient has BCBS plan-pos. Plan takes the labs and bundles 85018-QW, 85025 and 80053. They want us to
use code 80050-General wellness. It pays $ 37.00.
Thyroid 84443-can also be part of the 80050 instead of CMP 80053
What is your suggestion on this? We are clia waived and we are trying to order tests needed but insurance carriers are dictating what you can perform and how they will pay for each lab. ( losing money between the compliance and testing requirements. This is so important to do for our patients-Internal Medicine and Family practice group.
we are now asking the patient to pay for the UA - POS plans and HMO plans. we are asking patients to pay for labs in office and not bill the insurance because their insurance carrier is not paying.

SuperCoder Answered Fri 15th of August, 2014 12:32:07 PM

Thanks for your question. When billing labs you must make sure that the labs that you are billing separately are not included in a panel. Some insurance companies will deny the labs as bundled and some will just pay you for the appropriate panel on their own.

The General health panel 80050-- must include the following:
Comprehensive metabolic panel (80053)
Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004)
Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009)
Thyroid stimulating hormone (TSH) (84443)

These panel components are not intended to limit the performance of other tests. If one performs tests in addition to those specifically indicated for a particular panel, those tests should be reported separately in addition to the panel code.

Do not report two or more panel codes that include any of the same constituent tests performed from the same patient collection. If a group of tests overlaps two or more panels, report the panel that incorporates the greater number of tests to fulfill the code definition and report the remaining tests using individual test codes (eg, do not report 80047 in conjunction with 80053).

BCBS has denied because 80025, 80053, and 84443 are included in the general health panel which they want you to bill. You may bill the 85018 separately because it is not included in this panel. Hope this helps.

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