Wiki Follow up visits for normal labs

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clopez

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Hello,

On a recent audit I came across an Endocrinologist who schedules follow up visits to review results of blood tests ordered on a previous visit.
In my opinion these visits should not be billed to MCR or any Insurance when the test are perfectly nomal. My advice was that if the tests are abnormal and she needs to see the patient to discuss the visit can be billed based on time and to document the counseling provided to the patient. For normal tests I find it hard to meet medical necessity. Any thoughts or others who have come across this? Greatly appreciate any thoughts or views on this matter.

Cindy:)
 
The Clinical Laboratory Improvement Amendments (CLIA) program requires labs to report all results to the physician who ordered the tests, but there is no law that requires the physician to report all test results to the patient. However, ethical and legal considerations indicate that patients should at least be notified of abnormal results, and all practices should have a policy to that effect. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) will require all health care providers to ensure the privacy of personally identifiable health information, which may affect how patients are notified of test results.

Practices can use whatever method they prefer to notify patients of their results. For most practices, a phone call works best when immediate action is needed, although this can be time-consuming. For less immediate needs, test results can be mailed. Some practices notify patients of normal test results with a simple postcard bearing a pre-determined symbol (e.g., a ?smiley face?), rather than actual results, to preserve confidentiality. Other practices transfer this responsibility to patients, asking them to contact the office for their test results.
 
Hi Elizabeth,

Thank you very much, your response is very informative now if the practice chooses to schedule patients to review normal tests, I don't see how medical necessity would be met for such encounters therefore, these should not be billed to the patients insurance. Would you agree with that?
 
That is correct. If the patient has no complaints then there would not be a need to do an evaluation and management visit. If the lab is abnormal and the physician performs counseling, then the appropriate documentation would need to be documented (time spent counseling, topic discussed, etc.).
 
Correct- not just documentation drives an E/M. There must also be medical necessity for the service.
I audit providers and am constantly voicing this rule.
 
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