Q&A: Reporting date for service of collection for lab panels

Q: Under the introductory section of the CPT Manual’s Organ or Disease-Oriented Panels section, third paragraph, it is stated, "Do not report two or more panel codes that include any of the same constituent tests performed from the same patient collections." I am seeking clarification as to whether this literally means the same blood specimen collection or if it more generally means the same date of service (DOS) collection. In the hospital setting sometimes constituent tests are performed on the same DOS on an outpatient encounter, so it might lead one to report an applicable panel code. However, sometimes the constituents are not ordered at the same time, and the tests might be run from separate blood specimens drawn at different times, but still on the same DOS. Is there any guidance or reference that could clarify this?

A: If the panels are drawn at the same time and have some of the same components, you would report the more comprehensive panel and then the components of the second panel that are not included in the first. Reporting both panels raises the question, "Why is a component ordered and performed at the same time from the same blood draw?" The answer is because the practitioner ordered both panels.  When a panel is repeated at a later time on the same day, it is possible that it would be appropriate. But why is the full panel medically necessary? Why can't the components that were out of normal range be repeated rather than the full panel? For example, a comprehensive metabolic panel is ordered and resulted at 9 a.m. The patient's glucose and sodium are low but the remainder of the components are normal. The physician treats the low glucose and sodium and wants to recheck the levels at noon. Medical necessity would be supported for the glucose and sodium levels, but there is no reason to repeat the full panel as albumin, bilirubin, SGPT, and SGOT levels typically don't change much in a few hours.  (I have not considered any MUE and am using this for the purpose of an example only.)  The question in these scenarios are around the medical necessity of the test and not repeating "unnecessary" tests.

Editor’s note: This question was posted in the NAHRI forums and was answered by Denise Williams, COC, CHRI, senior vice president of revenue integrity services with Revant Solutions in Trussville, Alabama.