80053: Comprehensive metabolic panel

Effective for dates of service on and after January 1, 2012, A/B MACs (B) shall allow organ disease panel codes (i.e., HCPCS codes 80047, 80048, 80051, 80053, 80061, 80069, and 80076) to be billed by independent laboratories for AMCC panel tests furnished to ESRD eligible beneficiaries if: • The beneficiary is not receiving dialysis treatment for any reason (e.g., posttransplant beneficiaries), or

• The test is not related to the treatment of ESRD, in which case the supplier would append modifier “AY”.

Effective for dates of service on and after April 1, 2015, A/B MACs (A) shall allow organ disease panel codes (i.e., HCPCS codes 80047, 80048, 80051, 80053, 80061, 80069, and 80076) to be billed by ESRD facilities for AMCC panel tests furnished to ESRD eligible beneficiaries if:

• These codes best describe the laboratory services provided to the beneficiary, which are paid under the ESRD PPS, or

• The test is not related to the treatment of ESRD, in which case the ESRD facility would append modifier “AY” and the service may be paid separately from the ESRD PPS.

The organ and disease oriented panels (80048, 80051, 80053, and 80076) are subject to the 50 percent rule. However, clinical diagnostic laboratories shall not bill these services as panels, they must be billed individually. Laboratory tests that are not covered under  the composite rate and that are furnished to CAPD end stage renal disease (ESRD) patients dialyzing at home are billed in the same way as any other test furnished home patients.

“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 (e.g., do not report 80047 in conjunction with 80053).”

Based on the new information from CPT, UnitedHealthcare’s Laboratory Rebundling Policy will no longer consider the submission of CPT 80048- Basic Metabolic Panel plus CPT 80076-Hepatic Function Panel as reason to bundle to the Comprehensive Metabolic Panel code, CPT 80053.

However, should the same physician and/or other health care professional report CPT 80053 with CPT 80048 or CPT 80076 for the same patient on the same date of service, CPT 80048 or CPT 80076 will not be reimbursed separately. This also aligns with CPT coding guidance. CPT panel code 80053 includes all of the components of CPT panel code 80048 and all the components of CPT panel code 80076, except for CPT 82248. Therefore, the charges for CPT 82248 should be submitted separately when performed with CPT 80053 for the same date of service

Lab Panels Organ- or disease-oriented lab panels were developed to allow for coding of a group of tests. Providers are expected to bill the lab panel when all the tests listed within each panel are performed on the same date of service. When one or more of the tests within the panel are not performed on the same date of service, providers may bill each test individually. Providers may not bill for a panel and all the individual tests listed within that panel on the same day. However, other tests performed in addition to those listed on the panel on the same date of service may be reported separately, in addition to the panel code. Providers must follow CPT coding guidelines when reporting multiple panels. For example, providers cannot report basic panel code 80048 with comprehensive panel code 80053 on the same date of service, because all the lab tests in 80048 are components of 80053.




80051 QW 1. Abaxis Piccolo Blood Chemistry

Analyzer (Electrolyte Metabolic Reagent Disc){Whole Blood}

Abaxis, Inc. Measures carbon dioxide, chloride, potassium, and sodium in whole blood

2. Abaxis Piccolo xpress Chemistry Analyzer (Electrolyte Metabolic Reagent Disc){Whole Blood} Abaxis, Inc.

80053QW 1. Abaxis Piccolo Blood Chemistry Analyzer (Comprehensive Metabolic Reagent Disc){Whole Blood}

Abaxis, Inc. Measures alanine amino transferase, aspartate amino transferase, albumin, total bilirubin, total calcium, carbon dioxide, chloride, creatinine, glucose, alkaline phosphatase, potassium, total protein, sodium, and urea nitrogen in
whole blood





New Jersey Claim Review on HCPCS 80053 and 36415

In an effort to safeguard the Medicare Trust Fund by lowering the Comprehensive Error Rate Testing (CERT) paid claims error rate, Highmark Medicare Services’ Medical Review Department performs reviews and provides education based on data analysis performed to identify problem areas.  The CERT program is the driver of this data analysis.  The Centers for Medicare and Medicaid Services (CMS) and Highmark Medicare Services uses the information from the CERT error rate findings to determine the underlying reasons for claim errors and develops appropriate action plans to improve compliance in payment, claims processing, and provider billing practices.

Recent CERT data analysis indicated that there were multiple claim errors in New Jersey for procedure code 80053, Comprehensive Metabolic Panel, and procedure code 36415, Venipuncture.

As a result of this data analysis, Highmark Medicare Services’ Medical Review Department conducted a widespread post payment edit in New Jersey on procedure codes 80053 and 36415.

Our findings indicated that approximately 48% of the claims sampled were billed incorrectly.  The majority of the denials were based on the following:

     Physician orders were not signed and dated.
     No documentation in the medical record to indicate that the physician ordered the test.

As a result of these edit findings, and to reduce the overall claims payment error rate, a
prepayment edit will be implemented on procedure codes 80053 and 36415 for New Jersey providers.

Medical records will be requested to verify that services billed were rendered, medically necessary, adequately documented, and billed appropriately to the Medicare program.  If the requested medical record documentation is not made available upon request to support services billed, the service may be denied.



Unbundling of Services – identifies procedures that have been unbundled.

Example: Unbundling lab panels. If component lab codes are billed on a claim along with a more comprehensive lab panel code that more accurately represents the service performed, the software will bundle the component codes into the more comprehensive panel code. The software will also deny multiple claim lines and replace those lines with a single, more comprehensive panel code when the panel code is not already present on the claim.

Code Description Status

80053 Comprehensive Metabolic Panel Disallow

85025 Complete CBC, automated and automated & automated differential WBC count Disallow

84443 Thyroid Stimulating Hormone Disallow

80050 General Health Panel Allow

Explanation: 80053, 85025 and 84443 are included in the lab

Organ or Disease-Oriented Laboratory Panel Codes

**This section on Laboratory Panel Codes does not apply to the UnitedHealthcare CommunityMedicare Plans**

The Organ or Disease-Oriented Panels as defined in the CPT book are codes 80047, 80048, 80050, 80051, 80053, 80055, 80061, 80069, 80074, and 80076. According to the CPT book, these panels were developed for coding purposes only and are not to be interpreted as clinical parameters. UnitedHealthcare Community Plan uses CPT coding guidelines to define the components of each panel.

UnitedHealthcare Community Plan also considers an individual component code included in the more comprehensive Panel Code when reported on the same date of service by the Same Individual Physician or Other Health Care Professional. The Professional Edition of the CPT ® book, Organ or DiseaseOriented Panel section states: “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.”

For reimbursement purposes, UnitedHealthcare Community Plan differs from the CPT book’s inclusion of the specific number of Component Codes within an Organ or Disease-Oriented Panel. UnitedHealthcare Community Plan will deny the individual Component Codes and require the provider to submit the more comprehensive Panel Code. as set forth more fully in the tables below. The tables for CPT codes 80047, 80048, 80050, 80051, 80053, 80061, 80069, 80074 and 80076 identify the Component Codes that UnitedHealthcare Community Plan will require the submission of the specific panel.

Basic Metabolic Panel (Calcium, ionized), 80047

CPT coding guidelines indicate that a Basic Metabolic Panel (Calcium, ionized), CPT code 80047 should not be reported in conjunction with CPT code 80053. If a submission includes CPT 80047 and CPT 80053, both codes will be denied; the services will need to be resubmitted with CPT 80053 to be reimbursed.

There are 2 configurations for a Basic Metabolic Panel, CPT code 80047:

1. A submission that includes CPT code 82330 plus 4 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Basic Metabolic Panel (Calcium, ionized), CPT code 80047.


Basic Metabolic Panel (Calcium, total), 80048

CPT coding guidelines indicate that a Basic Metabolic Panel (Calcium, total), CPT code 80048 should not be reported in conjunction with 80053. If a submission includes CPT 80048 and CPT 80053, only CPT 80053 will be reimbursed. There are 2 configurations for a Basic Metabolic Panel (Calcium, total), CPT code 80048:

1. A submission that includes 5 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Basic Metabolic Panel (Calcium, total), CPT code 80048.



Panel Code Component Code  Code Description

80048 Basic Metabolic Panel (Calcium, total), 80048
Must contain 5 or more of the following Component Codes for the same
patient on the same date of service
82310 Calcium; total
82374 Carbon Dioxide (bicarbonate)
82435 Chloride; blood
82565 Creatinine; blood
82947 Glucose; quantitative, blood (except reagent strip)
84132 Potassium; serum, plasma or whole blood
84295 Sodium; serum, plasma or whole blood
84520 Urea nitrogen (BUN)

General Health Panel, 80050

A submission that includes a Comprehensive Metabolic Panel, CPT code 80053, a Thyroid Stimulating Hormone, CPT code 84443 and one of the following CBC or combination of CBC Component Codes, either CPT codes 85025 or 85027 + 85004 or 85027 + 85007 or 85025 + 85009 by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a General Health Panel, CPT code 80050.

80050 General Health Panel
Includes the following panel:
80053 Comprehensive Metabolic Panel
Includes the following component code:
84443 Thyroid Stimulating Hormone (TSH)
Plus one of the following CBC or combination of CBC Component Codes for the same patient on the same date of service:
85025 Blood Count; complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count 85027 + 85004
Blood Count; complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count)
AND
Blood count; automated differential WBC count
85027 +
85007
Blood Count; complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count)
AND
Blood count; blood smear, microscopic examination with manual differential WBC count
85027 +
85009
Blood Count; complete (CBC) automated (Hgb, Hct, RBC, WBC and platelet count)
AND
Blood count; manual differential WBC count, buffy coat When Hepatic Function Panel code 80076 is submitted on the same date of service by the Same Individual Physician or Other Health Care Professional for the same patient as General Health Panel code 80050, CPT code 80076 will not be separately reimbursed. Comprehensive Metabolic Panel code 80053, a component of Panel Code 80050, includes all components of Hepatic Function Code 80076 except for code 82248 (bilirubin, direct).



Comprehensive Metabolic Panel, 80053

There are 3 configurations for a Comprehensive Metabolic Panel, CPT code 80053: 1. A submission that includes 10 or more of the following laboratory Component Codes by the Same Individual Physician or Other Health Care Professional for the same patient on the same date of service is a reimbursable service as a Comprehensive Metabolic Panel, CPT code 80053.

80053 Comprehensive Metabolic Panel

Must contain 10 or more of the following Component Codes for the same patient on the same date of service:

82040 Albumin; serum, plasma or whole blood
82247 Bilirubin; total
82310 Calcium; total
82374 Carbon dioxide (bicarbonate)
82435 Chloride; blood
82565 Creatinine; blood
82947 Glucose quantitative, blood (except reagent strip)
84075 Phosphatase, alkaline
84132 Potassium; serum, plasma or whole blood
84155 Protein, total, except by refractometry; serum, plasma or whole blood
84295 Sodium; serum, plasma or whole blood
84450 Transferase, aspartate amino (AST) (SGOT)
84460 Transferase, alanine amino (ALT) (SGPT)
84520 Urea Nitrogen (BUN)