Wiki Proving Intent on Medicare Labs

[Stefanie]

In October 2010 we initiated our own laboratory. Since then I have been trying to get the providers to sign off on the orders/requistions to support medical necessity for lab tests. Currently we see a note from the nurse stating what labs were drawn and the diagnosis, but the provider doesn't sign the note. I know Medicare states an order nor a requisition form needs to be signed as long as the medical record (i.e. progress note) clearly states the intent of the labs ordered. My question is...would a progress note dated AFTER (a couple of days to a couple of weeks) the labs are drawn considered a supporting medical record for the labs? Also, what if the nurse note says V70.0 and lists all the labs and then the provider note doesn't indicate V70.0 but the note doesn't indicate specifically what the labs were for but the note states the results and the patient has hyperlipidemia, hypertension etc., but the note doesn't link the diagnoses with the labs? Anyone's input is very much appreciated. I have volumes of labs holding until I am comfortable with using the providers medical record to code.

 

[whaleheadking]

The requisition should be filled out appropriately and signed by the ordering provider. Supporting documentation elsewhere in the medical record is acceptable, but if it is written long after the fact, it doesn't support medical necessity as well as the initial requisition will. A progress note that coincides with when the req is submitted is better documentation, even if it is a transcription of a telephone order. It seems you need to communicate your requirements more clearly to your clinicians to avoid exposure to charges of abuse.

V70.0 is an overused code of last resort.

Good luck,
WK

 

[adevine]

This issue will only become more problematic once ICD-10-CM is in use! Your liason (Sales staff, folks in the lab, whomever) must educate your clinicians regarding their responsibility to provide pertinent and accurate clinical indications for EACH order. Each order should be able to "stand alone", with clear indication of why the order is being submitted. Often, provider staff will treat an outside lab as if that lab weren't outside their facility, assuming the lab has access to patient records. The clinician wouldn't send a patient to another provider without an appropriate clinical indication -- your lab is another provider!