decisionhealth Newsletters, Answer Books - 2008 Issue 12 (December)
Program_Memos / 2002 / AB-02-030
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Article Overview
This article explains Medicare administrative policies for clinical diagnostic laboratory services under Part B. It is relevant to billing, claims processing, and medical review staff who handle laboratory claims, and it covers topics such as diagnosis-code handling, claim documentation, ordering practitioner requirements, multiple-service reporting, narrative diagnosis use, and utilization review procedures. The memorandum also identifies effective and implementation dates and references CMS and related regulatory guidance.
Why This Topic Matters
Laboratory claims are subject to specific Medicare processing and documentation rules, and this memorandum summarizes how those rules were being applied in 2002. Understanding the scope of the guidance helps providers and billers determine whether the article is relevant to claim submission, review, or compliance workflows.
Article Sections
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Scope and Background
Introduces the memorandum, its purpose, and the Medicare policy context for clinical diagnostic laboratory services.
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Policy
Describes the general applicability of the administrative policies and the types of laboratory services and settings covered.
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Implementation
Outlines the operational guidance that follows for claims processing and related administrative procedures.
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A. Limitation on Number of Diagnosis Codes
Addresses claim processing considerations when diagnosis information exceeds a contractor’s system capacity.
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B. Diagnosis and Procedure Codes Matching
Discusses review of submitted diagnosis information and claim-processing approaches for services that are not covered.
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C. Ordering Practitioner
Identifies who may order services and references qualifications tied to practitioner status.
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D. Multiple Services
Covers reporting of multiple services on the same day and the use of specific CPT modifiers.
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E. Narrative Diagnosis
Explains handling of narrative diagnosis information and electronic versus paper claim submission.
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F. Documentation Requirements
Summarizes documentation retention and review expectations for ordering physicians and laboratories.
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G. Utilization Parameters (Frequency Screens)
Addresses utilization review limits, frequency-based denials, and related review exceptions.
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NOTE
Provides a clarification of the term used in the utilization discussion and references related manual guidance.
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H. Signature on Requisition Form
Explains expectations related to physician signatures on laboratory requisitions and other acceptable documentation.
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I. Provider Education
Directs contractors on provider outreach and publication of the memorandum’s information.
What You Will Learn
- The Medicare administrative scope of clinical diagnostic laboratory claim processing guidance
- How laboratory claim documentation and diagnosis information are handled
- Which categories of practitioners and claim review activities are addressed
- How multiple-service reporting and narrative diagnosis handling are discussed
- What general utilization review and provider education topics are included
Who Should Read This
- Medical coders
- Laboratory billing staff
- Claims processing staff
- Medicare compliance staff
- Medical review personnel
- Physician office billing teams
Codes Discussed
Modifiers Discussed
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