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Reader Question: Name Unique Lab Panels for Easy Identification

Question: When our endocrinologist orders an evocative or suppression test for hormones, he doesn't always order just the tests included in one of the CPT lab panel codes. He may order all the tests included in one panel plus a few extra, or he may create his own panel, so to speak, by ordering a list of tests that don't neatly fit into any one lab panel code. How are we supposed to code for these lab services?

New Jersey Subscriber

Answer: Altered lab panels can certainly be a source of confusion for endocrinology coders. Some panels are very straightforward, such as 80400 (ACTH stimulation panel; for adrenal insufficiency), which includes only Cortisol (82533 x 2). But many other lab panels include a much longer list of required tests that a physician may wish to tweak to meet a patient's specific needs.

When your physician orders a lab panel, the first thing you should do is look at the list of CPT lab panel codes to see if the ordered tests fit into a certain code.

If the ordered tests fall short of meeting all the requirements for a specified lab panel code, or if there's simply no code to describe the list of ordered tests, you have no choice but to report all the tests separately.

If the ordered tests fit into a specified code but there are some tests left over, report the appropriate lab panel code plus the additional tests separately.

Documentation, please: Physicians can clarify any lab panel confusion by documenting ordered lab panels with the same descriptions listed in the CPT manual. Instruct your physicians not to use abbreviations or other descriptions, but rather to write the names of the lab panels exactly as they appear in CPT. And if the physician orders a specified lab panel plus other tests, he should specify which CPT lab panel he is ordering, list all additional tests and give the overall test order a name, such as "Dr. Smith's panel." Naming an altered panel will quickly alert in-office coders or an outside reference lab that this order is a unique panel and may require separate billing of some component tests.