Question

question 23

a physician orders a general health panel, all tests except a creatinine, including cbc with automated differential. what cpt® code(s) is/are reported?

80050-22
85025, 84443, 82040, 82247, 82310, 82374, 82435, 82947, 84075, 84132, 84155, 84295, 84460, 84450, 84520
80050-52
80050

Explanation:

Analyze CPT panel coding rules

According to CPT guidelines for Organ or Disease-Oriented Panels, a panel code (such as General Health Panel 80050) must not be reported unless all tests listed in the panel definition are performed. If any test of the panel is omitted, the individual component tests must be coded separately instead of using the panel code with a modifier (such as -52 for reduced services).

Identify the missing component

The General Health Panel (CPT 80050) consists of:

• Comprehensive Metabolic Panel (80053)
• Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85520) OR CBC, automated (85027) and hemogram (85004 or 85007)
• Thyroid stimulating hormone (TSH) (84443)

The Comprehensive Metabolic Panel (80053) includes creatinine (82565). Because creatinine was not performed, the criteria for 80053 are not met, which in turn means the criteria for the General Health Panel (80050) are not met.

Determine the correct individual codes

Since the panel cannot be billed, each individual test performed must be reported separately:

• CBC with automated differential: 85025
• TSH: 84443
• Remaining components of the Comprehensive Metabolic Panel (excluding creatinine 82565):
• Albumin: 82040
• Bilirubin, total: 82247
• Calcium: 82310
• Carbon dioxide (bicarbonate): 82374
• Chloride: 82435
• Glucose: 82947
• Phosphatase, alkaline: 84075
• Potassium: 84132
• Protein, total: 84155
• Sodium: 84295
• Transferase, alanine amino (ALT): 84460
• Transferase, aspartate amino (AST): 84450
• Urea nitrogen (BUN): 84520

Answer:

• (A) 80050-22
• (B) 85025, 84443, 82040, 82247, 82310, 82374, 82435, 82947, 84075, 84132, 84155, 84295, 84460, 84450, 84520 (Correct answer)
• (C) 80050-52
• (D) 80050