CPT Code For CMP

(2022) CPT Code For CMP 80053 – Description, Guidelines, Reimbursement, Modifiers & Examples

The CPT Code For CMP is 80053 and stands for Comprehensive Metabolic Panel (CMP).

CPT 80053 is used for billing a wide range of blood tests that reveal information for multiple organ functions such as Kidney, Liver, blood sugar, calcium, electrolytes, calcium, PH balance, and other related blood measures.

These are all essential components that aid human bodily functions like glucose is used as a source of energy and electrolyte maintain fluids in the body. In addition, it is frequently used for screening purposes to rule out multiple conditions or abnormalities of certain organs. 

CPT Code For CMP Description

The CPT code for CMP 80053 panel consists of 14 diagnostic tests. For instance, a patient has come to the hospital, and Physicians ordered a series of pathology and laboratory tests. All these tests must be included in one panel to report CPT code 80053.

If any of them is not included in the panel, we cannot report the Panel code as per CPT coding guidelines. In this scenario, each test will be reported with an individual CPT code, or multiple groups of panels can be used to report all the components instead of the 80053 CPT code.

Suppose two panels overlap the components of CPT code 80053. In that case, report only the panel CPT code, which has a higher number of components instead of both, and the remaining tests will be reported with individual test CPT code.

All components of the panel must be met report Comprehensive Metabolic Panel (CMP) CPT 80053. The 80053 CPT code is approved by Clinical Laboratory Improvement Amendments (CLIA). Therefore, modifier QW is appropriate to append with CPT 80053.

This is the following list of tests that are included in the CMP CPT panel code (CPT 80053):

  • Calcium Total (CPT 82040)
  • Chloride (CPT 82435)
  • Albumin (CPT 82040)
  • Urea Nitrogen (UN) (CPT 84520)
  • Bilirubin (CPT 82247)
  • Carbon dioxide (Bicarbonate) (CPT 82374)
  • Creatinine (CPT 82565)
  • Glucose (CPT 82947)
  • Transferase, alanine amino (ALT) (SGPT) (CPT84460)
  • Phosphate, Alkaline (CPT 84075)
  • Potassium (CPT 84132)
  • Transferase, aspartate amino (AST) (SGOT) (CPT84450)
  • Protein, Total (CPT 84155)
  • Sodium (84295)

There are two panels, CPT codes 80048 (Basic metabolic panel) and 80076 (Hepatic function panel) are included in One panel (CPT code 80053).

These two CPT codes are not separately billable if all the components are met with 80053. Therefore, only CPT code 80553 will be reported.

80053

CPT Code For CMP 80053 Reimbursement

The cost of CPT 80053 is as follows according to CMS 2022 payment Schedules:

  1. CPT 80053 without QW modifier ($ 10.56)
  2. CPT With QW modifier ($ 10.56)

Only 1 unit of CPT 80053 can be reported on the same day, and three units are only applicable if medical documentation supports the service as medically necessary. RVUS is not applicable for CPT code 80053.

Panel CPT 80053 code is only used for coding purposes and does not influence any clinical parameters. It reports only one code (80053) instead of reporting all the 14 components with different CPT codes. 

Modifiers 

There are the following list modifiers applicable with CPT 80053: XE, XP, XU, XS, QW, QP, QJ, Q6, Q5, KX, GA, GC, GJ, GK, GR, GU, GX, GY, GZ, ET, EY, CR, CC, AI, 99, 22, 52, 59, 78, 79, 90, 91

Modifier 90 is appropriate to attach with CPT 80053 when service is performed by reporting or treating physicians.

The test would be processed by an outside laboratory. While modifier 59 will be used when CPT 80053 is not allowed to be billed together in conjunction with other procedures.

When CPT 80053 service is done more than once or repeated, Modifier 91 will be attached with CPT code 80053. For instance, Patients presented to the hospital with acute kidney injury, and the physician ordered the laboratory test to rule out the diagnosis.

Results revealed abnormal laboratory findings, and the Provider treated the diagnosis with medications. Physicians reordered the lab test to check that vitals were better or worse.

Modifier QW is appropriate to append with CPT 80053 as Its CLIA approved waived test. 

cmp modifiers

Billing Guidelines 

CPT Code 80053 billing guidelines are as follows:

CPT code 80053 services should be medically necessary and appropriate and not be bundled with other panels codes. 

CPT 80053 service should be met and regulated under CLIA (1988) for patients’ screening, testing, or treatment purposes.

CPT Code 80053 panel code is only used for coding purposes, and it would not affect any clinical condition. It contains 14 components and is appropriate to the bill when all the components are met and performed on the same date of service (DOS) on the same patient by the Same Physician or other qualified other healthcare professional.

CPT 80053 consists of 3 different combinations. It can be reported in three separate ways instead of billing as one panel CPT code 80053 if appropriate or if any component is missing in the Panel code.

First combination, all codes can be billed by individual CPT Code which includes CPT Codes (84520, 84460, 84295, 84450, 84155, 84132, 84075, 82040, 82310, 82435, 82247, 82947, 82565, 84132).

2nd Combination, CPT 80053, can be alternatively billed by one panel CPT code (80048) and combined with 7 Individual CPT codes (82040, 84075, 84460, 84450, 82247).

3rd combination, CPT code 80053, will be billed separately by one panel CPT code 80051 with the following 10 Individual CPT Codes (82040, 82247, 82310, 82565, 82947,84075, 84520, 84460, 84450).

Modifier AY is applicable with CPT code 80053 for Medicare Part B services. CPT 80053 is associated with Organ or Disease oriented panels. When lab and pathology tests are not related to end-stage renal diseases (ESRD) or treatment of ESRD, modifier AY will be attached to this type of service provided by the physician.

Suppose the test specimens are retrieved by Venipuncture (like CPT code 36415) in combination with CPT code 800053. It is appropriate to bill both services separately. 

There is the following list of Place of service (POS) codes that applies to CPT 80053:

Facility POS are 21, 19, 26, 23, 34, 51, 52, 55, 61, 57, while the rest are considered as non-facility POS like POS 11, 22, etc. 

CPT 80053 Examples

The following examples are when the CPT code for CMP 80053 may be used.

Example 1

A 52-year-old female with PMH of pituitary mass, brain bleed, HTN, diabetes here for left arm weakness, left-sided mouth numbness, left chest numbness that lasted 3-4 minutes an hour before heading to the ER.

Pt also endorses her sister telling her she spoke differently yesterday over the phone. Pt does not have SX currently. Pt’s neurologist is Dr. Yevgency Azrieli, who scheduled the Pt for an MRI w/ contrast for her recently discovered pituitary mass on CT for further workup. In addition, the physician ordered further studies on CBC, CMP, CXR, etc.

Example 2

The patient is a 41-year-old female with a significant PMH of acute right MCA stroke (in 12/13/21), non-verbal and non-ambulatory at baseline, who presents to the emergency department BIBEMS from Regency for evaluation of tachycardia today.

Per Regency, the patient’s heart rate was in the 150s today, prompting them to call EMS. Of note, the patient has had seven strokes in the past 1.5 years and has been admitted at Montefiore. In the past month, the patient has been at Regency NH.

Further history and ROS are limited because the patient is nonverbal at baseline.

Example 3

A 63-year-old male with a significant PMH of IDDM, BPH (on finasteride), and PE with saddle embolus presents to the emergency department to evaluate weakness for seven days.

The patient reports he has not seen his Dr. XYZ in a year but states he called her and told her he ran out of insulin.

He states she advised him to go to her office next week. He reports he has been increasingly weak for the past seven days.

He states he was insatiably drinking water today. He notes he took his blood sugar and saw it was high, prompting his arrival to the ED today.

The patient also endorses polyuria. The patient is COVID-vaccinated. The patient denies fever, chills, nausea, vomiting, or diarrhea. The patient denies chest pain, SOB, or cough.

The patient denies hematuria, dysuria, urgency, or frequency. The patient denies any other symptoms. Physicians plan to do CBC, CMP, and cardiac profiles.

Example 4

A 75-year-old female with a significant PMH of prior CVA (baseline nonverbal, trach/pegged), COPD, HTN, HF, AFib (on Eliquis), IDA, and functional quadriplegic who presents to the emergency department BIBEMS from Adira Nursing Home for evaluation of bleeding from the G tube site today.

Per EMS, the bleeding was stopped en route with a padded dressing. Per EMS, the patient was also sent to the ED for a low hemoglobin level of 6.2. Further history and ROS cannot be obtained due to the patient being nonverbal at baseline.

The differential dx is GI bleeding, Abcess from the stoma, dislodged stoma. EKG was reviewed and interpreted by the physician.

The physician plans to do the following studies: CBC, CMP, TROP, VBG, and order multiple diagnostic tests from the radiology section.

A moderate to marked atherosclerotic stenosis is seen within the proximal aspect of the celiac artery.

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