Physician's Orders for Diagnostic Laboratory Tests

Comprehensive Error Rate Testing (CERT) analysis has revealed an increase in errors for diagnostic laboratory services. The CERT errors are attributed to the absence of documentation supporting physician orders or physician intent to have diagnostic laboratory tests performed. Submission of appropriate documentation in a timely manner will decrease the number of errors and claims denied by the CERT contractor.

An "order" is a communication from the treating physician/practitioner requesting that a diagnostic test be performed for a beneficiary. The medical record and/or the request itself must clearly document the physician's intent for the diagnostic test to be performed.

Examples of Acceptable Documentation

  • A signed order (or signed requisition), by the physician.
    • An order (or requisition) not signed by the physician does not support physician's intent for the test to be performed.
  • A notation in the patient's medical record documenting the need for or the intent to obtain a specific test, signed by the physician.
  • A verbal or telephone order
    • Must be documented at both the treating physician's office and the testing facility and placed in the beneficiary's medical record.
    • Must be signed within the time frame specified by the state.
  • An email from the physician that may be verified as coming from the physician.
  • Other types of electronic requisition transmitted from the treating physician to the testing facility that requires a password, with proof of the process in writing (e.g. attestation).

Tests not ordered by the physician who is treating the beneficiary are not reimbursable. Although no signature is required on an order form for a clinical diagnostic test paid on the Laboratory Fee Schedule, the physician must clearly document and sign in the medical record, his or her intent to have the test performed. The entity providing the laboratory test results must maintain all documentation, including the physician order and the test findings, to support the claim submitted. Laboratory medical records are requested to determine correct billing and medical necessity.

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Last Updated Dec 06 , 2022