HGB A1C testing

[CompBeth]

Since the Hgb A1C tests should not be performed more frequently than every 3 months, what do you do if the patient brings an order into the lab 2 months after the last test? Go ahead and perform it, but credit it? If the lab keeps the script, would that mean the patient would have to go back to his physician to obtain another one?

[Gumby]

There are many reasons that one might test the Hgb A1c before the three month time frame. New medication may make it necessary to retest. A patient A1c may be so high that the risk factors associated with a high A1c might require a retest to be performed before the three month time frame. As far as coverage by insurance some policies may pay for it before the three month time frame and other may not. I would go ahead and charge for the test and keep physician order on file. It is not the laboratory responsibility to see that insurance will cover the tests but that there is a vaild order and perfrom test that are needed in the care of the patient. Did the order say repeat testing every two month X _ .

[Bill]

"It is not the laboratory responsibility to see that insurance will cover the tests..." This statement is contrary to the Medicare regs concerning ABN's. If this is a medicare patient, it is the lab responsibilty to inform the patient that it is not covered and that he/she would have to pay for it. Many insurance companies have followed similar policies--if you do not have a signed sheet (ABN) by the patient that he/she may have to pay, then you cannot collect for the test.

[Bill]

CompBeth, if there is no date as to when to do the test, I would explain that insurance will not pay, then let the patent decide when to have the test done. If the patient wants it done at 2 months, get an ABN signed.

[Gumby]

I understand that an ABN form needs to be filled out for a Medicare patient. Your computer system should notify you that one is required. There is not a mandate that you notify any patient other than Medicare that their insurance is not going to cover tests that a physician orders. In my pervious employments we had the largest reference lab in the state of Mississippi. Do you think that a patient with a severly elevated A1c should take medications that are not correcting the pateints blood sugar. There are severe complication that occur if a patient's A1c is elevated over 7.0 .

Complication of the eye lower extremities and coronary artery blockages. As I know that you are well aware an elevated blood sugar causes placking of all intra vascular material to the artery and venious walls. I think that a 30- or 40 dollar test charged to a patient would offset the knowledge that the patients medication and or change in diet is working to lower his A1c.

[CompBeth]

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?

[Gumby]

It is not that the diagnosis code is incorrect. The diagnosis code should be the same Type II or I diabetes. The best way to resolve the issue of when testing is to be performed would be to call the doctors office and see when he wanted the test to be performed. We had a outreach Manager and staff that would handle those issues. They would call and see when the next testing was to be performed and educate the office staff to include a date when future orders were to be performed. We had some office that would write scripts for testing to be performed on specific date and fax it over to our facility. Educating the doctors office would be the first place to start.