To: Physician Customers of the Clinical Laboratory

Memorandum Date: March 1st, 2010

To: Physician Customers of the Clinical Laboratory

From: William E. Check, Laboratory Medical Director

Bill Seignious, Laboratory Administrative Director

Lynn H. Ernst, Outreach/Quality Svc Manager Contact: 350-3261 or 350-8013

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This is our annual Outreach Laboratory Testing compliance letter for our physician customers. Please note the below updates and/or changes. Please feel free to call if you have any questions regarding our laboratory services.

Requirement of ABN documentation/New ABN form:

ABN denials are increasing, and this negatively affects our revenue. A new ABN form which requires additional testing information was revised in late 2008. This ABN form is on the back of all the outpatient laboratory requisitions. Please ensure ABNs are completed and submitted on all your non-contract patients.

Laboratory Order Documentation:

In an attempt to avoid abuse of prescription orders CMS recommended and Memorial’s Medical Executive Committee voted to not allow physician orders to be placed on prescription pads. Accordingly, physician orders for lab tests may no longer be written on prescription pads. Lab orders should be written on lab requisition forms or Physician’s Lab Order forms. We can customize your lab requisitions or supply you with the Physician’s Lab Order forms. The Physician’s Lab Order forms are also available from Moore (R.R. Donnnely) as form #9966 (08/09).

Medical Necessity/ICD Codes:

The laboratory continues to have daily issues with missing or inappropriate diagnoses codes. It is a CMS requirement to submit appropriate ICD-9 codes along with the ordered tests. The laboratory must call for missing codes; this is extra work/time for both our staff and yours, and it delays laboratory testing as well.

Quality Specimens/Patient Identification:

Patient specimens collected in the office must be submitted using the proper collection techniques, the appropriate container/volume, and with two separate identifiers. We require the patient’s full name and date of birth, and the date and time of collection.

CPT Code Changes:

Deleted CPT Code: 86781, Treponema pallidum confirmatory test

Deleted CPT Code: 823 07, 25 hydroxy vitamin D, use 82305 instead

New Laboratory Technology and or Testing for 2009/2010:

·  Patient safety enhanced by Mobile Care Phlebotomy in the Units

·  Auto-validation implemented for CBC’s to improve Turn-around Times

·  MRSA/MRSS SSTI Protocol in Microbiology

·  PNA FISH Testing in Microbiology

·  Implemented Blood Bank Sickle Cell Protocol

·  Offering ANA/IFA as a new test; must be on a manual requisition.

·  Installed several new instruments in Chemistry and Hematology to improve turn-around and stay abreast with technology

AMA Panels:

Our Laboratory offers only the AMA approved panels. The panels with test contents are listed below and are also stated on the back of our outreach requisition form. Panels are paid and billed when all components are medically necessary. Panels should not be ordered if one or more individual tests will be sufficient.

AMA Approved Panels, CPT’s, and Tests Included

Panel / CPT Code / Tests Included
BMP / 80048 / CO2,Chloride,Creatinine, Glucose, Potassium, Sodium, Bun, Calcium
CMP / 80053 / Above plus: Albumin, Bilirubin total, Alkaline Phosphatase, Protein, SGOT (AST), SGPT (ALT),
Electrolyte Panel / 80051 / CO2, Chloride, Potassium, Sodium
General Health Panel / 80050 / CMP, CBC Automated, TSH
Hepatic Function Panel / 80076 / Albumin, Bilirubin Total, Bilirubin Direct, Alkaline Phosphatase, SGPT (ALT), SGOT (AST), Protein total
Acute Hepatitis Profile (Acute) / 80074 / Hepatitis A ab (HAAb), IGM ab Hepatitis B core ab (HbcAb), IGM ab Hepatitis B surface Antigen (HbsAg), Hepatitis C ab (HCV)
Lipid Panel/Profile / 80061 / Cholesterol, HDL, Triglycerides
Obstetric Panel
*may not use if
FTA rather than RPR ordered. / 80055 / CBC Automated, HBsAg, Rubella Ab, RPR, Ab Screen, Rh
Renal Function Panel / 80069 / Albumin, Calcium, CO2, Chloride, Creatinine, Glucose, Phosphorus Inorganic, Potassium, Sodium, Urea Nitrogen

Reflex Testing:

The following reflex tests will be performed at an additional charge:

Cryptococcal Ab / If positive, a titer will be done
HCV Ab / If positive, reflex to RBA or HCV RNA will be performed
Reticuolocyte count / Automated retics will reflex to a manual retic if flagged
ANA / If screen is positive, a titer will be performed and pattern reported
RPR
*CPT new code 86780 / If screen if positive, a titer will be performed and FTA may be done
HIV Antibody Screen / If positive, a confirmation by Western Blot will be performed
CBC with Auto Diff / If certain flags/criteria are met, a manual diff will be performed
Antibody Screen / If screen is positive, Ab ID and/or Ab Id Level 2 and/or Ab elution and/or Ref Lab may be performed.
Pos Antibody Screen on In-Patient / 2 unit anti-globulin crossmatch
Pos Auto Control on Antibody ID / Direct Coombs will be performed; unit antigen or patient antigen may be performed as well.
Direct Coombs / If positive, Ab elution and/or Cord Immune Ab may be performed
Antibody Titer / Antibody ID and/or Antibody ID Level 2 will be ordered per specimen
Urine Drug Screens / If positive, a confirmation of drug class id done if patient < = 1year old
Cultures, Any Source
*CPT code 87153 or 87150 if nucleic acid probe identification. / If indicated by growth gram stains, ID’s, or sensitivities will be performed
SSTI-Rapid PCR for MRSA/MRSA / All will be reflexed to superficial wnd