Coding lab slips

Hi,

I am doing a project to help my hospital lab with some coding issues. I just happened across this site=)

I believe we have a problem with Doctors sending patients with un-coded lab slips and some phlebotomists have been just using codes like V70.0 to get the order in our system.. not fully understanding that this causes a problem for billing. And medi=care audits...

I was always under the impression it is "against the law" for phlebotomists or registration personnel to code anything without contacting the patients doctor.. doesn't this teeter on insurance fraud?

How do I really find out the guidelines for lawful coding... It has been my understanding that as a phlebotomist that we can never code an un-coded lab slip without documenting that we got the code from the patients doctor.

And what is with the differing information about whether or not medicare actually pays for things like V58.61 as the primary / only code on a PT lab slip. Does it need a condition diagnosis also to have no issues with reimbursement?

Any direction would be greatly appreciated!

re: Coding lab slips

If you the lab is billing the insurance of Medicare for the testing, you ABSOLUTELY need a diagnosis from the doctor, either in words or a ICD code. You cannot put in a diagnosis yourself. If you are contracted with the doctor, where their office pays you for the tests he orders, then you don't.

As to covered codes, go here https://www.cms.gov/coveragegeninfo/04_labncds.asp to get the coverage lists for Medicare. V58.61 is ok for protimes.

re: Coding lab slips

Wow, that is a great resource! Thanks =)

I have been through a lot of documents and still can not find a statement I can actually cite in my project saying:

It is absolutely against the law to bill with a code we can not document where it came from. I know billing does some cleaning up of coding errors, but some things are getting billed with codes some phlebotomists are just putting in because they may think it is appropriate for the test.

ex: I went in to work last weekend and there was a list someone had made with lab test names and codes they can use for those tests... some of the codes were ridiculous.. like CMP - 285.9 ( Anemia) or another one they listed is HGBA1C - v58.69. ( I was furious someone even considered making this list and then that used irrelevant codes!) I have to hope that people aren't getting un coded lab slips, seeing even PT and knowing to put V59.61 without contacting the Dr. so they can document where the code came from.

The use of V70.0 on un coded lab slips seems to be a major source of denials for lab work at our facility. But now seeing this list someone made makes me wonder how deep the problem really is.

I am trying hard to reeducate our staff. sigh.

ps: Anyhow if anyone knows where I can cite a source for the use of undocumented codes, especially on labs, I would be insanely grateful!