CompBeth

All, I'm training a few new people and the question of which modifier to use on some common lab tests came up again. One example is on the GAM (IgG, IgA, IgM). 91 or 59? Thanks, Beth.

Sounds like a good idea--thanks!

Hi--we are changing how we charge for outpatient blood draws and I'm wondering if we should charge for inpatient draws (done by phlebotomists, not nurses) as well? Does anyone know if there are rules about this?

Hi--actually, it was a senior coder that was temporarily assigned to the lab charts who asked me about this and sent over what she was working on. I know CMS wants there to be a valid dx for each lab test performed. "Pre Op Labs" isn't one. I'm just wondering how others deal with it? Thanks!

Hello--I was just given a stack of charts for patients who had lab tests performed before their outpatient procedure. The problem is that the ordering providers listed the diagnoses for the labs as "pre-op labs" or "hip replacement", etc, not a reason why the labs are medically necessary. Has anyone found a successful way of handling this issue? Thanks!

Thank you...sounds like a good move for us. Can you please affirm that you're reporting only the 82247 CPT code for the result, however?

We have recently moved our testing to new Ortho analyzers. To get the result reported out as "Neonatal Bilirubin", the new analyzer measures total bili (82247) and direct bili (82248). Then a calculation is made with those results, conjugated and unconjugated bili and a delta bili to produce the neonatal bili result. We were told to report the end result using code 82247. Does anyone know if that is correct?

Thank you, Brenda. This is the realization we've come to, as well. Due to system limitations, we have to have someone manually credit the fees and we were looking at all possible solutions to resolve this 'glitch' in the process. Ah, well. Better to do it correctly, though tediously than quickly and wrong!

Hello--we bill for the urine culture alone, but I've recently heard that we could also be billing for the colony count. Anyone know anything about this?

The other question is, can the registrars or office staff at the hospital or clinic call to obtain the missing diagnosis, or does it have to be lab techs or other clinical personnel?

If the lab receives and order containing an invalid diagnosis, i.e. with symbols indicating 'below' or 'above', or words like 'rule-out' or 'probable'...will the lab be okay in calling the physician's office and writing down what he says, or does a change in the code demand a physician's signature? Thanks!

Hello--when a diagnosis code is missing from an order, is it okay to call the physician's office and obtain the code over the phone, or does it require a fax? Can a lab tech or registrar accept the code over the phone, or does it take a clinician? Thanks!

That was my thought as well, except it is a different department than Blood Bank (radiology) who will lose money. I suppose we could come up with a way to 'pay' them a lump sum each month...?

We've drawn up a substitution policy stating that all orders for blood platelets will be filled with irradiated blood platelets. The question is, do we continue to charge the irradiation fee that belongs to radiology if the order does not specify 'irradiated'?

The problem is, how do we match up the patients with frequent HGBA1C tests with acceptable vs unacceptable diagnosis codes? Do you routinely audit for this?