25.3.3.13 Hospital Laboratory ServicesThe American Medical Association (AMA) has discontinued the following general multichannel automated panel codes:
These panel codes were discontinued because the panel did not define exactly what tests are performed. The new organ and disease panel codes 5-80048, 5-80051, 5-80053, 5-80069, and 5-80076 must be used instead of the general multichannel automated panel codes in the table above. The CPT procedure codes in the table above should not be used as billing codes, but the payment amounts associated with pricing of these automated profiles will continue. For example, if two automated profile tests are performed, the individual codes for the two automated tests must be billed instead of code 5-80002. For pricing, count the number of automated profile tests billed, and payment will be at the same rate as the former code 5-80002. CMS continues to provide updated pricing for the deleted profiles of automated tests. The new organ or disease panels include the following codes:
Outpatient and inpatient claims for laboratory services must reflect only tests actually performed by the hospital laboratory. Exception: Hospital laboratories may bill for all the tests performed on a specimen if some but not all the tests are done by another laboratory on referral from the hospital submitting the claim. The billing hospital must enter the name and provider identifier of the performing laboratory in Block 80 of the UB-04 CMS-1450 claim form and must enter the performing laboratory's provider identifier next to the service provided by the performing laboratory. Hospitals may bill a handling fee procedure code (1-99001) for collecting and forwarding a specimen to a referral laboratory if the specimen is collected by venipuncture or catheterization. Only one handling fee may be charged per day, per client, unless specimens are sent to two or more different laboratories; this must be documented on the claim. Laboratory tests generally performed as a panel (chemistries, complete blood count [CBC], urinalyses) must be billed with the appropriate HCPCS panel code. The policy applies to laboratory tests performed by a hospital laboratory. Modifier 91 Modifier 91 should be used for repeat clinical diagnostic tests as follows:
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• When appealing claims with modifier 91 for repeat procedures, providers must separate the details. One detail should be appealed without the modifier and one detail with the modifier, or documentation of times for each repeated procedure. Modifier 76 The use of modifier 76 is limited as follows:
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• Certain procedure codes have been removed from modifier 76 auditing. These procedure codes have been identified as routinely being performed at the same time, more than twice per day for each antigen (e.g., agglutinins, febrile, [e.g., brucella, francisella, murine typhus, Q fever, Rocky Mountain spotted fever, scrub typhus], each antigen). Providers may still appeal claims for that have been denied for documentation of time. Most procedure codes initially requiring modifier 76 will continue to be audited for the 76 modifier. When appealing claims with modifier 76 for repeat procedures, providers must separate the details. One detail should be appealed without the modifier and one detail with the modifier, or documentation of times for each repeated procedure. Refer to: "Laboratory Paneling" for more information about laboratory paneling procedures. |
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Modifier 91 must not be used when billing the initial procedure. It must be used to indicate the clinical diagnostic retest.
