Laboratory tests were a groundbreaking discovery in the medical industry. Over the decades, testing has helped healthcare providers diagnose different medical conditions to provide a tailored treatment plan and save numerous lives.
Regardless of how miraculous this specialty is, the coding guidelines and hundreds of CPT codes do not spare it from the complexity of billing. Thus, we decided to help you in the best possible way. Well, by penning down a detailed laboratory CPT codes guide.
Yes, you read it right! This guide will present a list of CPT codes and also share the laboratory coding guidelines to help you get your rightful reimbursements.
So, without stalling, let’s dive right into the specifics!
Struggling with Laboratory Billing?
Common CPT Codes for Laboratory Services
Here’s a list of the most commonly used CPT codes for laboratory services:
CPT Code 80048 – Basic Metabolic Panel (BMP)
A healthcare provider may order a BMP test as it can offer insights about various metabolism and/or kidney issues of a patient in an emergency room.
You can report this laboratory CPT code when the lab analyst performs a BMP test for measuring the eight chemicals in the blood level, including creatinine, sodium, calcium, chloride, potassium, carbon dioxide, blood urea nitrogen, and glucose.
CPT Code 81002 – Under Urinalysis
This laboratory CPT code is related to urinalysis. You can order this test for pre-surgery preparations, pregnancy checkups, or a routine medical exam.
It involves collecting a urine specimen from the patient, and the lab analyst uses a dipstick or places a few drops of the urine sample on a reagent tablet. The analyst will then take the readings for the specific ordered tests by the physician after the proper time interval. However, this test does not include performing a microscopic analysis.
CPT Code 85025 – Complete Blood Count (CBC)
CBC is a great way to help identify patients with anemia or look for potential cases where the white blood cells drop significantly, hinting towards the dengue virus.
You can bill the 85025 CPT code for laboratory services when a technician or pathologist performs the CBC test at the provider’s request. It involves collecting a blood specimen via a syringe and storing it in a test tube with an anticoagulant to avoid blood clotting. Nowadays, technicians use an automated analyzer to count the various types of blood cells.
CPT Code 80050 – Organ or Disease-Oriented Panels
You can report this laboratory CPT code when a lab analyst is tasked to perform a specific group of clinical laboratory tests in the general health panel. However, note that this CPT code should only be used when the provider specifically orders general health panel screening. Therefore, applying this code for component tests for diagnosis purposes may lead to claim denials.
CPT Code 87880 – Infectious Agent Antigen Detection
The 87880 CPT code for laboratory tests is for the detection of infectious agent antigens. It helps the healthcare provider verify whether a patient’s symptoms are due to an infectious disease. A professional analyst performs this immunoassay test with direct optical observation to identify group A, Streptococcus, in a collected throat swab sample from the patient.
CPT Code 87635 – Infectious Agent Antigen Detection by Nucleic Acid
It is related to a testing procedure just like the one we discussed above, 87880, to detect the infectious agent antigens. However, the technique used here is different, i.e., an amplified nucleic acid probe method.
Here, the analyst carries out the necessary steps to detect the nucleic acids from the SARS-COV-2 that result in COVID-19. Yes, it is a code that must have been billed the most during the pandemic, and it is still valid and one of the most common laboratory CPT codes.
CPT Code 86000 – Febrile Agglutinins Detection
This laboratory CPT code comes under the category of qualitative or semiquantitative immunoassays. Physicians order the lab analyst to look for febrile agglutinins, including Q fever, scrub typhus, Francisella, Rocky Mountain spotted fever, Murine typhus, Brucella, etc., in the patient’s blood sample. You can bill this code for each tested antigen.
CPT Code 80157 – Free Carbamazepine Detection
This technical lab test procedure is conducted to detect free carbamazepine in the collected blood specimens. If you want to bill the payer for this procedure, you should use the laboratory CPT code 80157, which comes under the therapeutic drug assays category.
For the unversed, providers use this medication, carbamazepine, to treat various psychiatric and neurological disorders, including epilepsy. Physicians often order this test because it enables them to identify the free amount of the medication, failing to bind to the protein, resulting in side effects or other adverse reactions.
CPT Code 81419 – Neurological Seizure Disorder Diagnostic Procedure
It is another common CPT code for laboratory services and falls under genomic sequencing procedures and other molecular multianalyte assays.
In this procedure, a genomic sequence analysis panel is performed on a specimen, such as blood. This test evaluates the genetic sequencing of at least twenty-four genes to help the physician in diagnosing a genetic predisposition to epilepsy, which often leads to neurological seizure disorder in patients.
CPT Code 86901 – Blood Type Detection
You will find this lab CPT code under the range of transfusion medicine procedures. It is a test conducted on the serum plasma as a specimen to determine the blood type within the Rh blood group system.
Laboratory Coding Guidelines
Do you find the CPT codes complex to select while billing for laboratory procedures? If yes, this section will make things simple for you! We have curated a detailed list of laboratory coding guidelines for you.
Use of Accurate CPT Codes
There are hundreds of CPT codes for laboratory services, which may make it challenging to identify which code to use for billing a specific lab/pathology procedure.
However, it is essential that you review codes thoroughly and select the one that accurately defines the rendered service. Besides, note that if a CPT code is listed under a specific specialty, it doesn’t restrict you from using it elsewhere.
Know When to Use Method Code
There will be scenarios where finding a CPT code that best describes the specific procedure will seem like finding a needle in a haystack and will only bring you to the conclusion that it is not listed anywhere.
In such situations, you should use the method code that precisely describes the performed procedure. Besides, you can use an unlisted service code coupled with the appropriate procedure description as a last resort.
You Can’t Code or Bill Mathematical Calculations
Many laboratory tests may require you to perform mathematical calculations to produce results or reports. However, these calculations cannot be coded or billed for reimbursements.
Use Appropriate Modifiers
Modifiers are available to help you supply additional information or alterations related to the performed procedures to the payer to ensure higher reimbursements. However, billing specialists often make blunders while using the modifier codes, which may result in payment delays and claim denials. Here’s a list of commonly used pathology/laboratory modifiers to help you out:
Modifier 90
You should add this modifier to a lab CPT code when the specimen is sent to a reference lab, but the physician’s office is eligible to bill for the rendered procedure.
Modifier 91
This modifier indicates a repeated pathology procedure.
Modifier 92
You can use it when you conduct the test using an alternate lab platform.
Modifier 59
It indicates that even though the CPT code is the same, the performed procedure is distinct.
Modifier 26
You can use this modifier to specify the professional component of a procedure, such as a physician’s interpretation of the test report.
Other Lab Coding Guidelines
Some of the other important coding guidelines that you should be aware of are listed below:
- All laboratory procedures are quantitative until otherwise specified in the code description.
- You may utilize your choice of method to perform a laboratory service until otherwise specified in the code description.
- The examined material can be from any source until otherwise specified in the code description.
- You can use the same CPT code for laboratory services when distinct and separate methods are utilized to obtain and report distinct and separate results.
Bottom Line
Laboratory CPT codes range from 80047- 89398, making coding a nightmare for lab technicians and referring healthcare providers. However, by listing some of the most commonly used lab CPT codes, we tried to help you understand the coding guidelines for various laboratory and pathology services.
Note that implementing the coding best practices, such as using appropriate modifiers, knowing when to use method codes, and using specific CPT codes to report lab services, will help you ensure timely reimbursements.
However, if you still find it difficult to code and bill for laboratory services in-house, you can get help from the very best in the industry, such as MediBill MD. We have certified professional coders (CPCs) and billing specialists under our umbrella, providing professional laboratory billing services.
