Documentation for Bacterial Culture Lab Tests

by  Medicare Learning Network
March 8th, 2018

The Medicare Learning Network provides guidance on how to prevent denials of Bacterial Culture Laboratory Tests and required documentation:

The following conditions must be met:

• Bacterial cultures must be ordered by the physician/NPP who is treating the beneficiary. The physician/ NPP is the one who furnishes a consultation or treats a beneficiary for a specific medical problem, and who uses the results in the management of the beneficiary’s specific medical problem. Tests not ordered by the physician/NPP treating the beneficiary are not reasonable and necessary.
• The physician/NPP who ordered the test must maintain documentation of medical necessity in the beneficiary’s medical record.
• Entities submitting a claim must maintain documentation received from the ordering physician/NPP.

Examples of documentation that may be requested for medical review of claims for laboratory tests, including bacterial cultures:

• Documentation of the order for the service billed (including information sufficient to enable CMS to identify and contact the ordering physician/NPP)
• Documentation showing accurate processing of the order and submission of the claim
• Diagnostic or other medical information supplied to the laboratory by the ordering physician/NPP, including any ICD-10-CM code or narrative description supplied

References:

• MLN Fact Sheet: Provider Compliance Tips for Laboratory Tests - Bacterial Cultures