In Office CLIA Lab billing


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Hello everyone! Hoping to get some insight from you all on this. We have a new client that is a pain management doctor, strictly seeing workers comp patients, and has an in office CLIA lab.
He sees the pt for an office visit 07/1/2020, orders a presumptive lab test (collection date 07/10/2020, actual lab test date 07/10/2020), and if supported, orders a definitive lab test. Definitive lab testing is done same day as presumptive (07/10/2020) per records.

We are unsure if both lab codes (80307+g0403) should be billed on the SAME claim form under LABs tax ix w/ CLIA # in box 23 for DOS 07/10/2020 (actual test date). We are confused as to which date to use for each type of test, and which tax id it goes under, MD Office or the Lab? We rcvd some advice to bill the presumptive under the md and the definitive under the lab. unsure if this is the proper way.

Previous billers are billing 99215 under md tax id dos 07/01, and then 80307 under lab for collection date 07/01/2020, and g0403 under lab for actual testing date 07/10/2020. Is it okay to use the collection date as the presumptive dos, and actual testing date for definitive dos?

We would appreciate any thoughts you have on this subject :]


True Blue
Clovis, CA
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If I understand, you have two entities. The physician and the lab. Two tax ID numbers, two NPI numbers, etc. Totally separate, just housed in one building. Doesn't matter who owns what. Think of it like this, what would you do if Quest was the lab in question.

The doctor bills the rapid test (or presumptive test). The date of service is the date of the test.

The lab bills the lab test (definitive). The date of service is the date of the test.