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Routine Labs

  1. Default Routine Labs
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    I'm seeing our providers placing an order for labs that reads like this: “Order routine fasting labs.” I have an issue with this because we do not have any policy or protocol that spells out what ‘routine' fasting labs are (BMP, CMP, glucose or lipids???) and a reason is not included (sign or symptom). Do you know of any basic ‘standard of care' that covers this topic and makes it alright for an order to read like this? Can anyone point me to guidance or a policy specifically re: protocol for ordering "routine" labs?

    Thanks so much.

  2. #2
    Default Routine labs
    I know routine labs is a common phrase. However, beyond reviewing conditions being screened for per medicare in their annual wellness visit, I'd be at a loss. And even then, the screening is age and gender based. And past that, labs for patients with specific diagnoses differ. So without an internal policy, not sure if routine labs has any specific meaning.
    Last edited by jackson7591; 07-27-2011 at 12:19 AM.

  3. #3
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    Quote Originally Posted by Catherine@i1Consulting.com View Post
    I'm seeing our providers placing an order for labs that reads like this: “Order routine fasting labs.” I have an issue with this because we do not have any policy or protocol that spells out what ‘routine' fasting labs are (BMP, CMP, glucose or lipids???) and a reason is not included (sign or symptom). Do you know of any basic ‘standard of care' that covers this topic and makes it alright for an order to read like this? Can anyone point me to guidance or a policy specifically re: protocol for ordering "routine" labs?

    Thanks so much.
    Documentation guidelines say this:
    "If not documented, the rationale for ordering diagnostic and other ancillary services should be easily inferred....
    The CPT and ICD-9-CM codes reported on the health insurance claim form
    or billing statement should be supported by the documentation in the
    medical record."

    Stating that "routine fasting labs" have been ordered, without any specific protocol in place as to what "routine" means, is risky. I personally wouldn't count it, if I were auditing it. The problem is that the word "routine" is subjective, even though it's a common phrase. One provider may consider only total cholesterol, HDL, and triglycerides to be "routine", but another provider may "routinely" order a direct measurement LDL as well, or a metabolic function panel instead of any of them. In order to report labs for reimbursement, documentation guidelines clearly state that the CPT codes must be supported by the documentation, and in my opinion, that means that they should be specified by name (or acronym, or something that tells me that the doctor requested that lab in particular). If it's too difficult to do that, they may consider utilizing a mini-superbill, or a lab requisition that allows them to select labs by their CPT codes or names, which can be attached/scanned into the medical record. Hope that helps!

  4. Default
    Thank you for your help!

  5. Default Routine Labs
    So what would use for your ICD 10 code ? My doctor has ordered CBC, PSA and BMP with a dx of routine. We are getting a lot of denials for our labs with unspecified dx.

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