Hello,
Amateur laboratory billing auditor here (4 months old), trying to find billing guidance on samples that have less than ideal sample integrity (i.e. grossly hemolyzed, lipemic, icteric). I am trying to resolve a situation with our automated chemistry instruments resulting tests with a integrity flag instead of a qualitative or quantitative result.
Examples:
1. Comprehensive Metabolic Panel (CMP) - All analytes, except for AST, have results. AST has been resulted as "Grossly Hemolyzed". Payer was billed for the entire CMP using CPT code 80053.
2. Quantitative Troponin - Sample resulted with "Grossley Hemolyzed". No quantitative results are available. Payer was billed using CPT code 84484.
Instinctively I'm assuming that you cannot bill for tests that are resulted with an integrity issue. But I am struggling to find any documentation or guidance on this! When is it appropriate to bill for a laboratory test, and when is it innapproriate.
Any help would be greatly appreciated!!!!
Amateur laboratory billing auditor here (4 months old), trying to find billing guidance on samples that have less than ideal sample integrity (i.e. grossly hemolyzed, lipemic, icteric). I am trying to resolve a situation with our automated chemistry instruments resulting tests with a integrity flag instead of a qualitative or quantitative result.
Examples:
1. Comprehensive Metabolic Panel (CMP) - All analytes, except for AST, have results. AST has been resulted as "Grossly Hemolyzed". Payer was billed for the entire CMP using CPT code 80053.
2. Quantitative Troponin - Sample resulted with "Grossley Hemolyzed". No quantitative results are available. Payer was billed using CPT code 84484.
Instinctively I'm assuming that you cannot bill for tests that are resulted with an integrity issue. But I am struggling to find any documentation or guidance on this! When is it appropriate to bill for a laboratory test, and when is it innapproriate.
Any help would be greatly appreciated!!!!