Should tests be ordered singly or in bunches? In general, one should order the test needed to go with the clinical indication, such as troponin for an acute coronary syndrome. However, some tests need to be interpreted in context with similar tests, such as electrolytes.
Medicare tends to drive test reimbursement strategies. In 1998 Medicare defined panels or groupings of automated tests for which it will pay, and stated that if one of the tests in a panel is deemed to be medically necessary, then this can justify all the tests in the panel. A single diagnosis, or ICD-10-CM code (such as E10.65 Type 1 diabetes mellitus with hyperglycemia) will be sufficient for all the tests in a panel, even though some tests might not otherwise qualify. These standard panels are listed below (with CPT codes for illustration):
Basic metabolic panel (CPT 80048)
|Carbon dioxide [bicarbonate]
Comprehensive metabolic panel (CPT 80054)
Albumin, Alkaline phosphatase, Aspartate aminotransferase [AST], Bilirubin, Calcium, Chloride, Creatinine, Glucose, Potassium, Protein, total, Sodium, and Urea nitrogen
Electrolyte panel (CPT 80051)
Carbon dioxide [bicarbonate], Chloride, Potassium, Sodium
Hepatic function panel (CPT 80076)
Alanine aminotransferase [ALT], Albumin, Alkaline phosphatase, Aspartate aminotransferase, ilirubin, total and direct, Protein, total, and Albumin
An individual practitioner could concoct a set of tests and define it as a "panel" but it would not necessarily be reimbursed, nor would such a panel necessarily be evidence-based. The purpose for restricting the number and use of panels is to diminish the amount of unnecessary testing performed.