Healthcare requires medical bills and records to be accurate. By doing this, healthcare providers get accurate pay and patients receive the healthcare services they need. Proper billing depends on using CPT (Current Procedural Terminology) codes.
They are actually standard abbreviations that doctors and medical personnel use to show their work for patients. The CPT code 80053 and 80048 are used quite often in laboratory testing.
While they both look the same, these codes include different tests and apply them differently. Our article can help you learn more about their differences.
What Are CPT Codes?
CPT codes are a five-digit system healthcare providers use to say what tests and procedures were done. Because of these codes, all medical billing uses the same descriptions for the same services. This way, hospitals, clinics, insurance firms, and Medicare can interact with less difficulty.
For example, a blood test that measures sugar typically gets its own CPT code. With that code, doctors can clearly discuss results and billing issues with the lab and billing team. The American Medical Association (AMA) makes and updates these codes.
CPT Code 80048 (Basic Metabolic Panel or BMP)
It is a fact that metabolism breaks down food molecules to provide energy and use it for proper body functioning. One of the most common metabolism codes is CPT code 80048 that relates with the Basic Metabolism Panel or BMP.
The 8 Tests in a Basic Metabolic Panel ICD-10 Are:
- Glucose checks your blood sugar levels.
- Calcium (total) makes bones, muscles and nerves strong.
- Sodium moves body fluids and makes nerves function properly.
- Potassium maintains your heart and muscles health.
- Chloride helps with fluid and acid/base balance.
- Carbon Dioxide (Bicarbonate) checks the acid and base balance in the blood.
- Blood Urea Nitrogen (BUN) regulates kidney function.
- Creatinine also checks kidney health.
What is the Purpose of CPT BMP?
Detects problems with metabolism.
Helps monitor kidney function.
Checks electrolyte levels and acid-base balance.
Often used during routine health screenings or hospital admissions.
The main reason for requesting a metabolic panel CPT code is when a basic health check-up is desired or if a patient has signs such as dehydration, confusion, or unusual heartbeats.
CPT Code 80053 (Comprehensive Metabolic Panel or CMP)
CPT code 80053 shows the Comprehensive Metabolic Panel or CMP. You will get all the tests in the BMP in addition to 6 special tests that help evaluate your liver and protein levels. All in all, the CMP has a total of 14 tests.
The 14 Tests in a CPT Code CMP Include
(Everything in BMP, plus the following)
- Albumin is a protein produced by the liver. Its level causes liver or kidney disease.
- Total Protein includes the amount of albumin, globulin and other proteins in the blood.
- Alkaline Phosphatase (ALP) enzyme leads to liver or bone problems.
- Alanine Aminotransferase (ALT) enzyme’s higher level cause liver damage.
- Aspartate Aminotransferase (AST) enzyme directly relates to liver and heart health.
- Total Bilirubin is the result of the breakdown of red blood cells. High levels often lead to jaundice or indicate liver issues.
What is the Purpose of CMP?
Comprehensive metabolic panel CPT code
Shows how each organ is functionally important.
Controls the blood levels of liver enzymes and checks how much protein is present.
Supports doctors in spotting liver diseases and checking their treatments.
Offers more information about health than the BMP.
That’s why doctors who want to have the deepest understanding of their patients’ internal organ health preferably choose the CPT code for CMP.
Main Difference Between CPT 80048 and 80053?
No doubt, both 80053 and 80048 are identical pairs of CPT codes and measure important blood values, but we will outline the main difference between them.
| Feature | CPT 80048 (BMP) | CPT 80053 (CMP) |
| Number of tests | 8 | 14 |
| Includes liver tests? | No | Yes |
| Includes protein tests? | No | Yes |
| Kidney and electrolyte check | Yes | Yes |
| Checks for liver disease | No | Yes |
| More comprehensive | No | Yes |
Experts consider the CPT CMP to go beyond the BMP in its recommendations. The BMP is a quick survey of a couple of rooms, but the CMP checks every part of the house, including the top and bottom floors.
Why Not Always Use the CMP?
While the 80053 CPT code description contains detailed data, it isn’t always needed. Symptoms can influence whether a doctor tests everything or just a few things. In those situations, a BMP can save project resources and decrease unneeded medical tests. Health professionals want to prevent unneeded testing since it might cause confusion or give inaccurate results.
Certain insurance companies may just cover tests your doctor considers necessary for your health. A CMP can be denied for reimbursement if the reason given for the request is unclear. So, picking the correct test is necessary because it can affect medical records and financial records.
Billing and Insurance Consideration
When you’re dealing with medical billing, you must obey the following rules to avoid extra expenses.
Mutual Exclusivity
80048 and 80053 CPT codes must not be charged together for the same patient on one day. The reason is that all of 80048 is already found in 80053. Billing both parties constitutes double billing, and it is not permitted.
Modifiers Do Not Apply
Sometimes, special information about billing is explained using modifiers. Billing both codes together by using a modifier is usually not considered appropriate. The NCCI clearly states that these codes should not both be reported at once, but only against related procedures.
Documentation Requirements
Proper recording of information is very important. Whenever a BMP or CMP is done by a provider, that reason should be documented in the patient’s chart. As a result, the right amount is invoiced to the patient or their insurance, as needed.
Who Orders These Tests?
The complete metabolic panel ICD-10 codes are typically ordered by:
- Primary care doctors
- Emergency room physicians
- Endocrinologists
- Nephrologists (kidney doctors)
- Gastroenterologists (liver specialists)
Rechecking these tests regularly is important for patients who have long-term illnesses such as kidney failure or liver disease. It helps doctors change treatments or medicines or carry out more tests.
Frequency and Timing
Both BMP and CMP are used as routine tests. You can order them.
- Each time you get an annual health assessment.
- Before a surgery, it’s necessary that the organ function does not change.
- If you have symptoms like being tired or feeling an unusual heartbeat.
- To follow up on ongoing diseases or regular health problems.
A blood draw is all you need for the tests, and your results are usually ready within 24 hours. Now, we will discuss another valuable CPT code that goes beyond CMP.
CPT Code 80050 (General Health Panel)
CPT code 80050 is an important but mostly misunderstood which is used for a General Health Panel. It consists of many tests such as Comprehensive Metabolic Panel (80053), a Complete Blood Count (CBC), and a Thyroid Stimulating Hormone (TSH) test. It is best for annual physicals or wellness visits, where the physician needs a clear picture of a patient’s overall health.
Final Thoughts!
Learning about the distinct features of CPT codes 80048 and 80053 is useful for everyone working with medical care, billing, and patients. Although they are both useful, doctors choose one over the other depending on what information they need. When doctors learn the purposes and timing of laboratory tests, they can help patients, avoid problems with bills, and use money wisely.
Reach out to a healthcare provider or medical billing expert when you’re not sure which code to use. Proper coding gives you the proper payment and enables good medical decisions and effective treatment.
Related Reading: If you’re also working with imaging codes, learn the differences between Carotid Duplex CPT Codes 93880 and 93882
