decisionhealth Newsletters, Answer Books - 2010 Issue 7 (July)
Labs in Physician Offices / Section II_Office lab coding and reimbursement tips
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Article Overview
This article reviews practical issues affecting physician office laboratory billing and reimbursement, including documentation alignment, medical necessity, requisition practices, panel awareness, compliance review, and Medicare coverage considerations. It also discusses laboratory reporting scenarios involving influenza testing and the use of CPT modifier guidance for repeat or distinct laboratory services. The content is aimed at office lab staff, coders, billers, compliance personnel, and physicians who order in-office testing.
Why This Topic Matters
Office laboratory claims are highly vulnerable to denial, overbilling concerns, and compliance risk if orders, documentation, and reported services do not match. This article helps readers understand the broader compliance and reporting issues that affect reimbursement and audit exposure in physician office labs.
Article Sections
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6 steps to code in-office labs for cleaner, clearer reimbursement
Introduces office laboratory billing concerns and broad compliance themes related to accurate reporting, medical necessity, requisitions, and coverage awareness.
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Lab compliance audit checklist
Presents a compliance-focused checklist for reviewing office laboratory coding, billing, requisitions, monitoring, and internal controls.
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2 flu tests on one device? Use modifier 59
Explains influenza testing scenarios and general reporting considerations involving laboratory modifiers and repeat testing concepts.
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Modifier 59 Versus Modifier 91
Compares two laboratory modifier concepts in the context of distinct services and repeat diagnostic testing.
What You Will Learn
- How office laboratory billing and documentation issues affect reimbursement and compliance
- What broad areas to review on a lab compliance audit checklist
- How influenza testing scenarios can affect laboratory reporting
- How laboratory modifier guidance is discussed in relation to distinct and repeat testing
- How coverage policies and requisition practices relate to office lab claims
Who Should Read This
- Physician office laboratory staff
- Medical coders
- Medical billers
- Compliance personnel
- Physicians who order in-office laboratory testing
- Practice managers
Codes Discussed
Modifiers Discussed
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