[Urine Culture Screening?]

Good question. I like to refer to CMS's Lab NCD 23. Item 190.12 discusses Urine cultures. It calls out the 4 hot dipstick items (Leukocyte esterase, blood, nitrites and protein) plus microscopic findings of WBC, RBC and/or bacteria that may indicate that a culture is needed.

http://http://www.cms.gov/CoverageGenInfo/04_LabNCDs.asp

But, it also indicates that a patient's symptoms may also indicate a need for a urine culture.

To empower the physician to place orders that are "Reasonable and Medically Necessary", we built three different test groups in Meditech 6.0.

1. Urinalysis (dip and micro if indicated) the doctor would need to specifically add a culture.

2. UA w Culture if Indicated (CIF) (Reflex policy needed)

3. UA and culture

The Executive Medical Committee at your hospital would need to define the reflex lab test policy, review once a year and get sign-off from medical staff that they understand the policy.(Per Office of Inspector General policy)

Finally, consider that with the advent of ARRA, CMS can withhold payment if they think a UTI was obtained while in the hospital.

Your lab director, lab teams and hospital quality assurance team need to have a conversation about whether to error on the side of caution to perform a few more cultures than needed.....as opposed to not getting paid for a DRG. Yikes.

[Use of CPT Code 86885]

My understanding is that 86885 is for the manual tube antibody screen and 86850 is for the PEG screen. PEG pays a lot more.

[Charging for crossmatches]

The answer lies with your Medicare Administravtive Contractor (MAC) for Indiana. However, neither CPTs 86920 (IS) nor 86922 (AHG) are mutually exclusive, so I would bill for each. For more info on Medicaly Unlikely Edits and Mutually Exclusive Edits, I use cms.gov, then enter NCCI in the search.

[Electronic crossmatch billing setup]

CMS allows OPPS payment for 86923. $14.93 per unit.

[Type and Screen and Hold-Do labs use this order?]

Type and Screen and Hold-Do labs use this order? In a multi-lab software build, a few sites really want this orderable so they can segregate pre-op specimens. It can be built as inactive so that labs who don't use it would not see it in the lab order catalog. Thoughts?

[Crossmatch Billing]

I looked at the CMS Medically Unlike Edits and saw that 86920 (IS) and 86921 (inc) are mutually exclusive. Does anyone else interpret it that way? look at CMS.gov

[Can I charge for a RedCell LeukoReduced P9016 even though just a Packed RedCell P9021 is ordered?]

Our blood supplier only sends leukoreduced Packed cells. If we write a reflex policy that informs the doctors that an order for Packed Red Cells will be charged as a Packed Red Cells-Leukoreduced- is that legit?