Common Laboratory Service Findings - JF Part A
Common Laboratory Service Findings
Comprehensive Error Rate Testing (CERT) analysis has indicated errors when billing Urinalysis automated (UA), with microscopy CPT 81001 and Complete Blood Count (CBC), with differential CPT 85027. Upon medical review of submitted documentation, the physician written order indicates UA testing but does not indicate microscopy or CBC with no indication of the differential.
- Appropriate billing, based on the specific ordered service, is CPT 81003 vs. 81001 for the UA or 85025 vs. 85027 for the CBC. Submitting claim(s) for diagnostic tests without the physician approval is a coding error.
The laboratory may have a protocol to complete a microscopy when the UA is ordered or complete a CBC with differential when the order only states CBC; however, Medicare does not accept protocols as orders. Physicians must clearly document, in the medical record, his/her intent that a particular test(s) be performed as well as support the necessity of the testing to be completed.
It is important for providers to review documentation and coverage guidelines in the National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). This will assist with proper billing and decrease CERT errors. Access policy information from the Policies webpage.
