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By Namas | Published August 9th, 2019 - Last Review/Update August 14th, 2019
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
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By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published February 13th, 2019
This question was asked on the following lab codes used for testing during pregnancy. "Can the codes below be billed together? 87491- 59, 87591-59. 87081, 87150."
YES- CPT code 87081 is used when a specific pathogen is suspected and is appropriate.
YES- (X2) 87150 is used for culture, typing, and identification by nucleic ...
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By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 3rd, 2019
For 2019 a new code has been introduced (81443) which represents genetic testing for 15 genes associated with severe, inherited conditions. The results of this test may be used to identify carrier status during prenatal genetic counseling, confirm a clinical diagnosis, or identify at-risk family members for the following severe ...
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By Find-A-Code | Published October 17th, 2018
Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average...
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Bladder/Urothelial Tumor Markers (Jurisdiction F)
September 20th, 2017
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published September 20th, 2017
CMS recently released a new LCD for Jurisdiction F, Bladder/Urothelial Tumor Markers (L36680).
Documentation Requirements
The medical record must clearly identify the number and frequency of bladder marker testing. Medical record documentation must be legible, must be maintained in the patient’s medical record (hard copy or electronic copy), and must meet the ...
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Preventive Services: Cardiovascular Disease Screening Tests
September 1st, 2017
By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018
The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Cardiovascular Disease Screening Tests:
80061 -
Lipid panel, this panel must include the following:
82465 - Cholesterol, serum, total
83718 - Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol)
84478 - Triglycerides
Z13.6
All Medicare beneficiaries without apparent signs or symptoms ...
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Preventive Services: Lung Cancer Counseling and Annual Screening for Lung Cancer With LDCT
September 1st, 2017
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Lung Cancer Screening Counseling, and Annual Screening for Lung Cancer With Low Dose Computed Tomography (LDCT)....
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Preventive Services: Screening for STIs and High Intensity Behavioral Counseling (HIBC) to Prevent STIs
September 1st, 2017
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs.....
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Preventive Services: Screening Mammography
September 1st, 2017
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on a Screening Mammography....
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Preventive Services: Screening Pap Tests
September 1st, 2017
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Screening Pap Tests....
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Preventive Services: Screening Pelvic Examinations
September 1st, 2017
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Screening Pelvic Examinations (includes a clinical breast examination)....
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Medicare Will Use Private Payor Prices to Set Payment Rates for Clinical Diagnostic Laboratory Tests Starting in 2018
June 23rd, 2016
By Brittney Murdock, QCC, CMCS, CPC | Published June 23rd, 2016
Today, the Centers for Medicare & Medicaid Services (CMS) released a final rule implementing Section 216(a) of the Protecting Access to Medicare Act of 2014 (PAMA), requiring laboratories performing clinical diagnostic laboratory tests to report the amounts paid by private insurers for laboratory tests. Medicare will use these private insurer ...
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PQRS Measures by Specialty (2016)
March 29th, 2016
By InstaCode Institute | Published March 29th, 2016
Download CMS's Preferred PQRS Measures Lists by Specialty. 17 Specialties to choose from. Find out exactly what CMS is expecting to see reported for your specialty.
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Maternal Serum (Prenatal Screening for Down Syndrome) Testing Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform maternal serum testing.
...
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Medium Chain Acyl-CoA Dehydrogenase (MCAD) Deficiency
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform MCAD deficiency testing.
...
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Mitochondrial Disorder Testing Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform mitochondrial disorder testing.
...
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Molecular Genetic Testing Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform molecular genetic testing.
...
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Mucopolysaccharidosis (MPS) Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform MPS testing.
...
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Multiple Endocrine Neoplasia 1 (MEN1) Gene Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform Multiple Endocrine Neoplasia Type 1 (MEN1), Gene testing.
...
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Multiple Endocrine Neoplasia 2, RET Gene
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform Multiple Endocrine Neoplasia 2, RET Gene testing.
...
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MUTYH - Associated Polyposis Testing Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform MUTYH-associated polyposis testing.
...
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Neurofibromatosis Type 1 (NF1)/Legius Syndrome Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform Neurofibromatosis Type I/Legius Syndrome Testing.
...
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Non-Invasive Prenatal Testing (NIPT) Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
Patient History Form For Non-Invasive Prenatal Testing (NIPT)
...
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Noonan or Leopard Syndrome Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform molecular genetic testing.
...
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Ogden Syndrome Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform molecular genetic testing.
...
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Ornithine Transcarbamylase Deficiency (OTC)
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform OTC deficiency testing.
...
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Pancreatitis Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform pancreatitis DNA testing.
...
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Periodic Fever Syndromes Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform periodic fever syndromes testing.
...
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Prenatal Cytogenetics Testing Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform prenatal cytogenetic testing.
...
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Prenatal or Expanded Carrier Screening Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform prenatal or expanded carrier screening
...
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Primary Carnitine Deficiency (SLC22A5) Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform Primary Carnitine Deficiency (SLC22A5) testing.
...
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Primary Congenital Glaucoma (CYP1B1) Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform primary congential glaucoma (CYP1B1) testing.
...
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PTEN Hamartoma Tumor Syndrome (PHTS) Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform PHTS testing.
...
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Pulmonary Arterial Hypertension (PAH) Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform Pulmonary Arterial Hypertension (PAH) testing.
...
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RASA-1 Related Disorders Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform RASA1 gene testing.
...
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Retinitis Pigmentosa Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform retinitis pigmentosa/leber congenital amaurosis testing.
...
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Rett Syndrome (MECP2) or CDKL5-Related Disorders Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform Rett Syndrome (MECP2) or (CDKL5) testing.
...
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Very Long Chain ACYL-CoA Dehydrogenase (VLCAD) Deficiency Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform VLCAD deficiency testing.
...
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von Willebrand Disease (VWD) Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform von Willebrand (VWD) testing.
...
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Warfarin Sensitivity Genotyping (CYP2C9 and VKORC1) Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform warfarin sensitivity genotyping
...
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X-Chromosome Microarray Testing Form - Free
March 8th, 2016
By Find-A-Code | Published March 8th, 2016
This form is required to perform X-Chromosome Microarray testing.
...
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Hypertrophic Cardiomyopathy (HCM) Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perfrom Hypertrophic Cardiomyopathy (HCM) testing.
...
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Inherited Insulin Receptor Conditions Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform INSR testing.
...
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Juvenile Polyposis Syndrome (JPS)/Hereditary Hemorrhagic Telangiectasia (HHT) Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform JPS/HHT testing.
...
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Laminopathies (LMNA) Gene Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform Laminopathies (LMNA) gene testing.
...
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Legius Syndrome Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform Neurofibromatosis Type I/Legius Syndrome testing.
...
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Loeys-Dietz Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform Loeys-Dietz testing.
...
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Lynch Syndrome/HNPCC Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform Lynch Syndrome/HNPCC testing.
...
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Marfan Syndrome (FBN1) Gene Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform Marfan (FBNI) gene testing.
...
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Cystic Fibrosis (CF) Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform cystic fibrosis testing.
...
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Cytogenetic (Chromosome) Testing, Pediatric/Adult Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform cytogenetic (chromosome) studies.
...
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Cytogenetic (Chromosome) Testing, Microarray - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
Genomic Microarray Patient Clinical Information Form
...
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Ehlers-Danlos Syndrome Kyphoscoliotic (Type VI) Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform EDS VI testing.
...
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Exome Sequencing with Symptom-Guided Analysis Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform exome sequence testing.
...
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Exome Sequencing Control, Family Member Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform exome sequence testing.
...
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Familial Adenomatous Polyposis Testing Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform Familial Adenomatous Polyposis testing.
...
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Familial Cerebral Cavernous Malformation (CCM) form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform Familial Cerebral Cavernous Malformation (CCM) testing.
...
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Familial Mediterranean Fever Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform periodic fever syndromes testing.
...
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Family Specific Mutation Testing Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform family specific mutation testing.
...
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Fetal Fibronectin Testing Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform fetal fibronectin testing.
...
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Fetal Molecular Testing Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform fetal molecular testing.
...
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FG Syndrome Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform FG Syndrome testing.
...
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Freeman-Sheldon Syndrome Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform Freeman-Sheldon Syndrome testing.
...
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G6PD Deficiency Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform G6PD deficiency testing.
...
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Galactosemia Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform galactosemia DNA testing.
...
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Genomic Microarray Testing Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
Genomic Microarray Patient Clinical Information Form
...
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Hearing Loss form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform hearing loss testing.
...
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Hemoglobinopathy/Thalassemia Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform hemoglobinopathy/thalassemia testing.
...
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Hemophilia A or B Gene Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform hemophilia A or B Gene testing.
...
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Hereditary Hemorrhagic Telangiesctasia (HHT) Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform HHT molecular genetic testing.
...
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Hereditary Paraganglioma-Pheochromocytoma Form - Free
March 7th, 2016
By Find-A-Code | Published March 7th, 2016
This form is required to perform hereditary paraganglioma-pheochromocytoma testing.
...
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Alport Syndrome Testing Form - Free
March 3rd, 2016
By Find-A-Code | Published March 3rd, 2016
This form is required to perform Alport Syndrome Testing
...
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Angelman Syndrome Form - Free
March 3rd, 2016
By Find-A-Code | Published March 3rd, 2016
This form is required to perform Angelman Syndrome DNA testing
...
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Aortopathy Testing Form - Free
March 3rd, 2016
By Find-A-Code | Published March 3rd, 2016
This form is required to perform aortopathy testing
...
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ATP7A Testing Form - Free
March 3rd, 2016
By Find-A-Code | Published March 3rd, 2016
This form is required to perform ATP7A genetic testing.
...
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Biochemical Genetic Testing Form - Free
March 3rd, 2016
By Find-A-Code | Published March 3rd, 2016
This form is required to perform biochemical genetic testing
...
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Biotinidase Deficiency Form - Free
March 3rd, 2016
By Find-A-Code | Published March 3rd, 2016
This form is required to perform Biotinidase DNA testing.
...
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Cardiac Genetic Testing Form - Free
March 3rd, 2016
By Find-A-Code | Published March 3rd, 2016
This form is required to perform cardiology genetic testing.
...
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Citrin Deficiency Form - Free
March 3rd, 2016
By Find-A-Code | Published March 3rd, 2016
This form is required to perform SLC25A13 genetic testing.
...
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Citrullinemia Type 1 (ASS 1) Sequencing Form - Free
March 3rd, 2016
By Find-A-Code | Published March 3rd, 2016
This form is required to perform ASSI genetic testing.
...
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Connexin (Hearing Loss) Form - Free
March 3rd, 2016
By Find-A-Code | Published March 3rd, 2016
This form is required to perform hearing loss testing
...
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Cytogenetic (Chromosome) Testing, Prenatal - Free
March 3rd, 2016
By Find-A-Code | Published March 3rd, 2016
This form is required to perform prenatal cytogenetic testing.
...
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Announcing Find-A-Codes newest addition - Medical /Lab Test Information
January 29th, 2016
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 29th, 2016
Announcing Find-A-Codes Newest product: Medical /Lab Test Information, available with your Find-A-Code subscription.Test information includes:
overview of the test
utility - when/why/how the test is used
diseases the test is often used to detect or monitor
specimen collection methods/procedures
testing methodology
usual turnaround time
interpretation of test results
reference ranges for test results (normal, abnormal, etc.)
diagnosis and billing ...
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Certificate for Provider - Performed Microscopy Procedures
January 29th, 2016
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 29th, 2016
Effective January 19, 1993, a laboratory that holds a certificate for provider-performed microscopy procedures may perform only those tests specified as provider-performed microscopy procedures and waived tests, as described below, and no others.
HCPCS Code Test
Q0111
Wet mounts, including preparations of vaginal, cervical or skin
specimens
Q0112
All potassium hydroxide (KOH)
preparations
Q0113
Pinworm examinations
Q0114
Fern test
Q0115
Post-coital direct, qualitative ...
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Von Hippel-Lindau Syndrome/Congenital Polycythemia (VHL) Form - Free
November 24th, 2015
By Find-A-Code | Published November 24th, 2015
This form is required to perform von Hippel-Lindau Syndrome/congenital polycythemia testing.
...
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Granulomatous Disease (CGD) Testing Form - Free
November 19th, 2015
By Find-A-Code | Published November 19th, 2015
This form is required to perform CGD testing.
...
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CLIA Categories and Subcategories
October 23rd, 2015
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 23rd, 2015
A laboratory may be licensed or exempted from licensure in several major categories of procedures. These major categories are listed in the Pub 100 Chapter 16-Labratory Services.
...
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Certificate of Waiver
October 21st, 2015
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 21st, 2015
Effective September 1, 1992, all laboratory testing sites (except as provided in 42 CFR 493.3(b)) must have either a CLIA certificate of waiver, certificate for provider -performed microscopy procedures, certificate of registration, certificate of compliance, or certificate of accreditation to legally perform clinical laboratory testing on specimens from individuals in ...
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Clinical Laboratory Improvement Amendments (CLIA) program MLN Matters Article
October 21st, 2015
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 21st, 2015
The Clinical Laboratory Improvement Amendments (CLIA) establishes a program to regulate laboratories that perform testing on patient specimens to ensure accurate and reliable test results. This fact sheet discusses:
■ Overview of the CLIA program;
■ Test categories;
■ How to enroll;
■ Types of certificates;
■ CLIA Proficiency Testing (PT); and
■ Resources
Read Entire article: ...
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Procedures Not Subject to Fee Schedule When Billed With Blood Products (Rev. 1, 10-01-03)
July 10th, 2015
By Find-A-Code | Published July 10th, 2015
The following codes are not subject to fee schedule limitations when submitted for payment on the same bill with charges for blood products. Rather, assume they are to be used for blood matching and not for diagnostic purposes.
Codes: 86901, 86905, 86930-86932, 86920-86922, 86890, 86870, 86891, 86880-86886, 86971, and 86930.
If no ...
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Method of Payment for Clinical Laboratory Tests - Place of Service Variation (Rev. 2971, 07-07-14)
July 9th, 2015
By Jared Staheli | Published July 9th, 2015
The following apply in determining the amount of Part B payment for clinical laboratory tests:
Laboratory tests not payable on the Clinical Diagnostic Laboratory Fee Schedule (CLFS) will be based on OPPS (for hospitals subject to OPPS) and current methodology for hospitals not subject to OPPS.
Independent laboratory or a physician or ...
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Billing for Split Unit of Blood
January 16th, 2015
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 16th, 2015 - Last Review/Update March 1st, 2016
Billing for Split Unit of Blood
(Rev. 1487, Issued: 04-08-08, Effective: 04-01-08, implementation: 04-07-08)
HCPCS code P9011 was created to identify situations where one unit of blood or a blood product is split, and some portion of the unit is transfused to one patient while the other portions are transfused to other patients ...
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