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Lab Billings

  1. #1
    Location
    Modesto, CA; Central Valley Chapter
    Posts
    225
    Default Lab Billings
    Medical Coding Books
    We have multiple clinics in multiple towns and several of labs where there are draw stations; and we have some CLIA waived tests that are done there in the physicians office.

    I'm trying to figure out how these should be billed. So an example is a patient on coumadin presents to his physician where the draw is done and processed right then for the INR.

    So do the charges go under our Lab director with the location (in which he is not located) or under the physician where the draw was done and the test processed?

    Thanks!
    Tina
    Tina Reich, CPC, CPC-I, CEMC

  2. Default
    Your post is not clear to me but will take a shot at it..........

    If the patient comes in and has the coumadin (fingerstick) as part of the visit with the Physician, then code the E&M for the visit and the 85610 (with -QW if medicare) for the coumadin

    If the patient comes in for a physician visit and a blood draw is done and the sample is sent to one of your other offices that has a lab and that lab will actually run the test, then code the E&M with the 36415 for the draw and the 99000 for the packing/prep of the sample. Your lab will code the CPT for whatever tests it runs

    Is this what you were asking?

  3. #3
    Location
    Modesto, CA; Central Valley Chapter
    Posts
    225
    Default
    Yes I think so....let me see...
    Patient arrives to his phyician at location A and has coumadin levels checked there in the office. The charges for the coumadin would then be billed under the physician.

    But
    Patient arrives to the lab and has coumadin levels checked then the charges for the coumadin would be billed under the lab physician.

    Is this correct/clear?

    Thanks
    Tina
    Tina Reich, CPC, CPC-I, CEMC

  4. Default
    Now you have me confused.

    I think we both are on the same page for the patient in the office, lab done and billed under the physician patient is seeing

    But the 2nd scenario. Patient goes direct to lab and had the test performed there. You want to bill under the lab director? Why wouldn't you bill under the physician who ordered the test?

    I could see the lab billing for the test if the lab was a separate facility/business such as ClinPath. But this is your own lab. I would think you are going to bill under the ordering physician

    I think I have also confused the issue with my previous response. When I stated "Your lab will code the CPT for whatever tests it runs", I was assuming a shared coding/billing system. I am used to the lab, pharmacy and Rad all being linked into a common central system. Meaning your lab would punch a button showing they performed the test and the system would produce the correct CPT to bill out under the ordering physician

    Maybe I am not understanding your scenario. You might want to get some input from some others in the forum

  5. #5
    Location
    will join Pasadena,Ca
    Posts
    19
    Default Lipid panel & hepatic function panel
    I AM A AUDITOR FOR 4 HOSPITALS. I HAVE A SITUATION. THE LAB PRESENTED ME WITH CPT CODES 80061,82465 AND 84478 (LIPID PANEL) and ALSO 80076.
    FROM MY UNDERSTANDING IF ANY COMPONENTS ARE MISSING FROM ANY PANEL, I CAN NOT BILL THE PANEL.IS THAT CORRECT. AND FINAL IN THE EVENT THAT I HAVE 2 SEPARATE PANELS WITH ALL OF THERE COMPONENTS INCLUDED, WOULD I BILL THE 1 OF THE PANELS WITH A -59 MOD?

  6. Default
    Quote Originally Posted by acodingangel View Post
    We have multiple clinics in multiple towns and several of labs where there are draw stations; and we have some CLIA waived tests that are done there in the physicians office.

    I'm trying to figure out how these should be billed. So an example is a patient on coumadin presents to his physician where the draw is done and processed right then for the INR.

    So do the charges go under our Lab director with the location (in which he is not located) or under the physician where the draw was done and the test processed?

    Thanks!
    Tina
    Tina,
    I work for a PPO in NC and we did an audit of lab claims and found that in some cases there were duplicate billings for the same CPT lb codes, billed by the lab and billed from the physician office. In some cases the lab employee was doing the blood draws so the lab billed for the venipuncture, in most cases the docto's office does the venipuncture. When we looked at claims, we noted the many CLIA waived tests, but also found that the lab was billing fro these same tests. The payor received two claims, one for lab and one from the MD office. When we contacted the physician's office, this had something to do with the MD office not checking a box in their claims system to inform the lab not to bill. This seemed to be human error...but we had to work out a way to identify duplicate billing. I think in some of the offices the MD office bills for the labs, then reimburses the contracted lab company on a monthly basis. It would all depend on that offices arrangement with the lab provider. I am really confused about this so if anyone can provide assistance, please respond!!
    Thanks!
    Jan

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