BHS LABORATORY SERVICES ANNUAL NOTICE TO PHYSICIANS 2013

BHS LABORATORY SERVICES
ANNUAL NOTICE TO PHYSICIANS
2013
Table of Contents
Page
Physician Letter…..……………………………………………………….….2
A. Medical Necessity (Out Patient Laboratory Testing)…………………..……...3
B. Preventive Medicine/ Approved Screening Tests……………………………..3
C. Advance Beneficiary Notice (ABN)……………………………………………..3
D. Medicare/Medicaid Fee Schedule and Review Policies……………………...3
E. Billing Requirements……………………………………………………..……....4
F. Diagnosis Information…………………………………………………………….4
G. Direct Billing……………………………………………………………………….4
H. Test Prices…………………………………………………………………………4
I. Ambiguous Orders…………………………………………………………………4
J. Patient Privacy (HIPAA)…………………………………………………………..4
K. Prohibited Referrals………………………………………………………………5
L. Inducements………………………………………………………………….…....5
M. Clinical Consultants..……………………………………………..……………….5
N. Compliance and Privacy Officers……………………………………………….5
O. New Tests and Description Changes…………………………………………..5
P. CMS Testing Panels…………….………………………….………………….…5
Q. Duplicate Ordering of Tests and Panels............…….………………………...6
R. BHS Reflex Testing..……………………………………………………………..6
BHS Laboratory Reflex Testing Algorithms………………………………7
S. Custom Organ and Disease Panels……………………………………………10
T. Test Substitutions/Order Clarifications……………………………………….....14
Commonly requested tests and resulting tests ………………………….14
U. New and Revised CPT Codes for Lab and Pathology, 2013………………...15
Page 1 of 15
ANNUAL NOTICE TO PHYSICIANS
Laboratory Services
2013
Dear Physician:
The Baptist Health System (BHS) Laboratories is providing this Annual Notice to Physicians as
required by the Office of Inspector General (OIG) and the Centers for Medicare/Medicaid
Services (CMS). The annual notice is in compliance with the regulations and requirements of
the OIG and serves as delineated guidelines used by BHS laboratories for submitting
reimbursement claims to Medicare/Medicaid for laboratory testing.
This notice serves to educate, update and inform physicians on issues related to compliance,
billing and coding practices of the clinical laboratory. In an effort to help laboratories comply
with federal laws and regulations, the general information contained in this notice applies to all
tests ordered within the Baptist Health System.
If you have any questions concerning the contents of this notice, including questions related to
medical necessity of testing, reflex testing, test name substitutions, etc., please contact me.
Respectfully,
Emily E. Volk, MD
Medical Director
Baptist Health System Regional Department of Pathology and Laboratory Medicine
Page 2 of 15
A. Medical Necessity (Out Patient Laboratory Testing)
As a physician you may order any tests, including screening tests, which you believe are appropriate for
the treatment of your patients. However, Medicare will only pay for tests that meet the Medicare/Medicaid
definition of medical necessity. Baptist Health System requires that a diagnosis code accompany all
outpatient diagnostic test requisitions. Panels should only be ordered when all component tests
are medically necessary. All other laboratory tests should be ordered separately.
B. Preventive Medicine/ Approved Screening Tests
Medicare provides reimbursement for specific laboratory tests when all of the following criteria are met:
1. The test is reasonable and necessary for the prevention or early detection of illness,
2. It is recommended by the US Preventive Services Task Force (USPSTF) with a grade of A or B,
and
3. It is appropriate for individuals entitled to benefits of the Medicare Program.
In many cases, specific screening ICD-9 codes must be provided with the test order for benefits to apply.
Tests with Preventive Services coverage are subject to frequency edits. Patients should be informed via
an ABN when tests are ordered more frequently than benefits allow.
Lab Test Description
HCPC/CPT Codes
Frequency Limitations
Lipid Testing: CHOL,TRIG,HDL
80061, 82465, 83718, 84478
Once every 5 years
Glucose Testing:
Fecal Occult Blood
82947, 82950
82951
G0328, 82270
One per year
2 per year
One per year
PSA
G0103
One per year
HIV
G0432, G0433
Chlamydia, Gonorrhea
87491, 87591
Syphilis Testing
86592, 8678 0
Hepatitis B surface Antigen
87340, 87341
One per year, if pregnant, 3X per
pregnancy
One per year , if pregnant 2X per
pregnancy
One per year, one per pregnancy
2X per pregnancy if at continued high
risk
One per pregnancy, 2X if at continued
high risk
C. Advance Beneficiary Notice (ABN)
CMS requires Medicare carriers to implement policies to ensure that services paid by Medicare are
medically necessary. Local carriers have established limited coverage policies under which Medicare can
deny reimbursement for tests based upon the absence of medical necessity, routine health screening,
investigational use only tests and frequency limitations. The patient is liable, providing that an ABN has
been given to the patient prior to service. An ABN signed by the patient prior to service is necessary to
document that the patient is aware that Medicare might not pay for the test and that the patient has
agreed to pay for testing in the event that Medicare payment is denied. The Advanced Beneficiary Notice
document will be generated, if necessary, at the time of patient registration.
D. Medicare/Medicaid Fee Schedule and Review Policies
Medicare/Medicaid will pay for organ or disease related panels only when all components are medically
necessary. Medicare/Medicaid payments will be equal to or less than the amounts set forth on the
Clinical Laboratory Fee Schedule.

This Fee Schedule is available for download from the CMS web site at: PHYSICIAN FEE
SCHEDULE
http://www.cms.hhs.gov/apps/ama/license.asp?file=/pfslookup/02_PFSsearch.asp

The local coverage determination (LCD/NCD) can be viewed at:
http://www.cms.hhs.gov/DeterminationProcess/04_LCDs.asp
Page 3 of 15
E. Billing Requirements:
All of the following information must be provided to enable our billing department to bill Medicare and/or
Medicaid:






patient’s full name;
patient’s date of birth and sex;
patient’s complete address, including city and zip code;
referring physician’s name and NPI
patient’s insurance ID number including suffix (Medicare beneficiaries),authorization number
(Medicaid beneficiaries); and
valid ICD-9-CM diagnosis code(s) for each encounter, not just for NCD/LCD limited coverage
tests.
F. Diagnosis Information:
CMS requires an ICD-9-CM diagnosis code on all claims. Additionally, diagnosis information is required
to establish the medical necessity of the tests ordered. Such information may be submitted either through
the use of ICD-9-CM codes or a narrative description. Only diagnosis information obtained from the
ordering physician is submitted on Medicare claims. The diagnosis information provided should reflect
information in the patient’s medical record for the date on which the physician wrote the order for the
tests. In the event an ordering physician does not provide diagnosis information, the physician
will be contacted to obtain such information. Documentation of the receipt of such information will be
maintained.
Documentation must be authenticated by the ordering physician or authorized
representative. All narrative diagnosis information received from ordering physicians will be accurately
translated into the appropriate ICD-9-CM codes.
G. Direct Billing:
Medicare requires the laboratory performing the test to bill the program directly. Physicians may not bill
Medicare for testing performed by a reference laboratory. Tests are reimbursed by Medicare
according to an established fee schedule. Medicaid reimbursement is equal to or less than the Medicare
fee schedule amount.
H. Test Prices:
Test pricing is based on the cost of each procedure or the component procedures included in a test panel
(direct costs), the costs associated with providing laboratory services for different types of customers
(indirect costs), reasonable accommodation of marketplace competitive pricing and a reasonable profit.
I. Ambiguous Orders:
Claims for reimbursements are submitted only for tests which have been both ordered and performed. If
the laboratory receives a requisition without a test ordered or with ambiguous orders subject to multiple
interpretations, the ordering physician will be contacted to determine what test(s) are to be performed
before testing is conducted or a claim for reimbursement is submitted. Inadequate or unacceptable
specimens will not be processed and no claim will be submitted. Claims are not submitted for results
derived by calculation.
J. Patient Privacy (HIPAA):
Under the Health Insurance Portability and Accountability Act (HIPAA), BHS Laboratory is a health care
provider and a covered entity. It is our policy to comply with the letter and intent of these standards. BHS
Laboratory will collect only the minimum necessary information and will treat all information collected in a
confidential manner within the confines of treatment, payment and healthcare operations. A copy of the
BHS Notice of Privacy Practices is available to physicians and patients on request. Any concerns
involving patient privacy may be addressed with the BHS Privacy Officer at 210-297-8264.
Page 4 of 15
K. Prohibited Referrals:
It is our policy to comply with all aspects of the self-referral prohibitions and exceptions established by
Stark I and II. The self-referral ban states that, if a financial relationship exists between a physician (or an
immediate family member) and a laboratory, the physician may not refer Medicare patients to that
laboratory, and the laboratory may not bill Medicare for services referred by the physician unless that
financial relationship satisfies all requirements of a regulatory exception for such a relationship.
L. Inducements:
Medicare law prohibits soliciting, offering, paying or accepting any “inducement” to secure the referral of
tests on Medicare patients. Only supplies and equipment necessary for the drawing, processing, storage
or transport of specimens and subsequent reporting of test results referred to BHS Laboratories are
provided to customers. No tests are provided to customers or potential customers free of charge or below
cost as a professional courtesy or to secure additional business. Any form of kickback, payment or other
inducement to secure the referral of Medicare specimens is strictly prohibited and should be reported to
the BHS Compliance Officer.
M. Clinical Consultants: The BHS Laboratories Clinical and Anatomic Pathologists are available to
provide assistance in selecting appropriate tests for a patient, condition, or other clinical situation where a
physician or other practitioner desires assistance. Clinical Consultation may be reached by contacting
any of the pathologists at the BHS Laboratories.
N. Compliance: You may direct questions about regulatory compliance and laboratory billing to the BHS
Compliance Office at (210) 297-1292
O. New Tests and Description Changes
The following new tests have been added to the laboratory’s test menu in the year 2013:
New Tests:
 MRSA/ MSSA by PCR
 Chlamydia trachomatis/Neisseria Gonorrhoeae by PCR
 Methotrexate (serum)
Description change:
Reticulocyte Panel (previously Reticulocyte Hgb concentrate)
Includes : Reticulocyte Hemoglobin, Immature Reticulocyte Fraction,
Reticulocyte Abs Count, Reticulocyte Percent
P. CMS Approved Testing Panels
The following are the approved testing panels performed by BHS laboratories.
BHS Testing Panel Name
BASIC METABOLIC PANEL (BMP)
CPT Code: 80048
Panel is composed of:
Na, K, Cl, CO2, Glucose, BUN, Creatinine,
Calcium
BASIC METABOLIC PANEL, POINT OF
CARE, IONIZED CA
CPT Code: 80047
COMPREHENSIVE METABOLIC PANEL
(CMP)
CPT Code : 80053
Na, K, Cl, CO2, Glucose, BUN, Creatinine,
ionized Calcium
Na, K, Cl, CO2, Glucose, BUN, Creatinine,
Calcium Total Protein, Albumin, Total Bilirubin,
Alkaline phosphatase, ALT, AST
Page 5 of 15
ELECTROLYTE PANEL
CPT Code: 80051
GENERAL HEALTH PANEL
CPT Code:80050
HEPATITIS ACUTE PANEL
CPT Code: 80074
Na, K, Cl, CO2
CBC with differential, CMP, TSH
Hepatitis A IgM antibody;, Hepatitis B surface
antibody,Hepatistis B core total antibody ,
Hepatitis B surface antigen,(HBsAg) Hepatitis C
IgM antibody
Alkaline Phosphatase, ALT, AST, Total and
Direct Bilirubin
Cholesterol Total, Triglyceride, HDL, LDL
Calculated
CBC with differential, HBsAg, Rubella antibody,
RPR, ABO, Rh, Antibody Screen
Na, K, Cl, CO2, Calcium,, Albumin, Glucose,
BUN, Creatinine, Phosphate,
HEPATIC FUNCTION PANEL
CPT Code: 80076
LIPID PANEL
CPT Code: 80061
OBSTETRIC PANEL
CPT Code: 80055
RENAL FUNCTION PANEL
CPT Code: 80069
Q. Duplicate Ordering of Tests and Panels
Every effort should be made to avoid duplicate ordering of tests. Examples are cited in the table, below:
Incorrect Order
CMP and Renal Function Panel
CMP and Hepatic Function Panel
BMP and Renal Function Panel
Correct Order
CMP and Phosphate
CMP and Bilirubin, Direct
Renal Function Panel
R. BHS Reflex Testing
Reflex testing occurs when the result(s) of a requested test automatically causes an additional test to be
ordered. Under certain conditions the laboratory will reflex the tests listed below according to the criteria
approved by the medical staff. Reflex testing is billed according to the individual test performed. Tests
that are referred to reference laboratories may also have reflexed, billable tests based upon the
guidelines of that reference laboratory.
Two types of reflex testing protocols are identified by the Centers for Medicare and Medicaid Services
(CMS) in the National Correct Coding Policy Manual for Medicare Part B Carriers (3 rd Edition, 1997). The
first type are laboratory tests which, if positive, require additional separate follow-up testing which CMS
indicates is implicit in the physician’s order. Furthermore, the initial test, if positive, requires the additional
testing to have clinical value. Reflex tests required by regulatory or accreditation standards are also
considered to be of this type.
The second type of reflex testing is those tests where the initial test result may have clinical value without
the additional testing. It is this type of reflex testing where CMS anticipates that the physician will be able
to use medical judgment in determining that for a specific patient during a particular episode of care, the
initial test provides sufficient clinical information and that the reflex test is not needed. It is in these
situations that hospitals and laboratories are required to offer the initial test without the reflex, if the
physician so orders.
Page 6 of 15
BHS Laboratory Reflex Testing algorithms
Ordered Test:
Criteria
Required Reflex Testing
Ordered:
ANA with Reflex to ANA
Panel
 Any positive or
equivocal result
ANA panel includes:
 Anti dsDNA quantative
 Anti Sm (Smith) IgG
 Anti SM/RNP IgG
 Anti SSA IgG
 Anti SSB IgG
 Anti Sci-70
 Anti JO-1 IgG
 Anti RNP
 Anti Centromere B
 Anti Chromatin
 Anti Ribosomal P
CBC/Platelet Count
Platelet count less than 50,000
CBC/Hemogram
LUPUS
ANTICOAGULANT Screen
Hgb <9g/dl and MCV <78
Positive result
Immature Platelet Fraction
(IPF)
Ret-HE
DRVVT2 (Sure)
DRVVTM 1:1
Prolonged PT/PTT
Evaluation
Pathologist selection:











HIV-1-2 Screen
Consultation Report (80500)
Thrombin Time (85670)
Hepzyme treated PT/PTT
(85610 & 85730)
PT/PTT Mixing Study(85732X3
& 85611X3)
Lupus Anticoagulant Screen
(DRVVT Screen &
Confirm(85613x2)STAClot
LA(85598)
Specific Factor Activity &
Inhibitors Factors II(85210),
V(85220),VII(85230),VIII(8524
0),IX (85250), X(85260),
XI(85270), XII(85280)
vonWillebrand factor
activity(85245)
vonWillebrand factor
antigen(85246)
Fibrinogen(85384)
Reptilase Time(85635)
Pre Kallikrein Screen(85292)
HMW Kininogen Screen
(85293)
Any positive or equivocal result
Page 7 of 15
Western Blot
Syphilis Screen (Syphilis
IgG)
Any positive or equivocal result
UA dipstick with reflex to
microscopic
Result is:
 Patient < 16 years old
 Positive for occult blood
 Positive for protein
 Not Normal in color
 Cloudy
 Positive for leukocyte
esterase with high specific
gravity
 High Specific gravity and high
glucose
UA dipstick with reflex to
microscopic and culture





Positive for occult blood
Positive for leukocyte
esterase
Positive for RBC’s
Positive for WBC’s
Positive for protein
If positive an RPR titer is
performed
UA dipstick with microscopic
UA dipstick with reflex to
microscopic and culture
Hbs Ag
Any positive or equivocal result
Hbs Ag neutralization
Microbiology Cultures
Identification of pathogen
Gram Stain
Anaerobic & aerobic cultures
performed as appropriate for
specimen source
Antibiotic sensitivity where
applicable. Sensitivity not
automatically performed on all
pathogens.
Microbiology Stool Culture
Stool Culture Positive for Shiga Toxin
E.Coli O157:H7 culture
Rapid Strep Group A
Any negative result
Streptococcal Screen Culture
Group A
Type and Screen
Positive antibody screen
Antibody Identification, Antigen
Testing and Two Unit Crossmatch
(this is going to change…the
criteria for this would be based
on whether or not the patient is
going to surgery, has a
hemoglobin <10 or has special
conditions (i.e. sickle cell)
Page 8 of 15
Rh on Mother and Baby
Rh negative mother/ Rh positive baby
Fetal Hemoglobin Screen
Positive result
Transfusion of any product
without current order for
type and screen
CSF Bactogen
Order for blood product transfusion
with no specific order for type and
screen
Negative or positive result
TSH W/Reflex
Abnormal result
Free T4
Protein Electrophoresis
Urine 24 HR or Random
Immunoelectrophoresis
Monoclonal spike
Possible monoclonal pattern
Hgb Electrophoresis
Presumed Hb-S
Abnormal patterns
Path review
Immunoelectrophoresis
Monoclonal gammopathies and
possible reflex to IgA. IgM IGG
and Kappa and Lambda light
chains
Acid Electrophoresis technique
Flow Cytometry
Leukemia/Lymphoma
Surgical and cytological
pathology
Surgical and cytological
pathology
Surgical and cytological
pathology
Surgical and cytological
pathology
Surgical and cytological
pathology
Surgical and cytological
pathology
Surgical and cytological
pathology
Breast cancer diagnosis made
Metastatic colorectal carcinoma
Metastatic or inoperable locally
advanced gastric cancer diagnosis
made
Plasma cell neoplasm diagnosis made
Head and Neck squamous cell
carcinoma diagnosis made
Diagnosis made of:
All primary colorectal or small
bowel carcinomas in patients below
the age of 50
All primary colorectal or small
bowel adenomas in patients below the
age of 40
All primary colorectal
carcinomas designated as “Mucinous”
type
All primary colorectal
carcinomas designated as “Signet
Ring” type
All primary colorectal
carcinomas exhibiting the so-called
“Crohn’s-Like” medullary pattern
All endometrial carcinoma
diagnosis made in women less
than 60 years old
Order Rhophylac (300mg)
Fetal Hemoglobin Scr.(85641)
Fetomaternal Bleed by Flow
Cytometry (86356)
Type and Screen
CSF Culture
Pathology reviews blood smear
prior to sending specimen for
testing.
Her2Neu testing by FISH and ER,
PR, Ki67 testing by IHC
KRAS testing by PCR
Her2 by FISH and, if negative,
Her2 by IHC
Myeloma prognostic panel by
FISH
P16 by IHC
Screening for HNPCC/Lynch
Syndrome by IHC.:
If staining for both MLH1 and
PMS2 is negative, BRAF
mutation with reflex to MLH1
Promoter Methylation will be
performed.
Screening for HNPCC/Lynch
Syndrome by IHC.:
If staining for both MLH1 and
PMS2 is negative, BRAF
mutation with reflex to MLH1
Promoter Methylation will be
Page 9 of 15
Surgical and cytological
pathology
Metastatic melanoma diagnosis made
Surgical and cytological
pathology
Surgical and cytological
pathology
Surgical and cytological
pathology
New myelodysplasia syndrome
diagnosis made
New acute myelogenous leukemia
(AML) diagnosis made
New myeloproliferative neoplasm
diagnosis made
Surgical and cytological
pathology
Surgical and cytological
pathology
BCR/ABL FISH positive
myeloproliferative neoplasm
New adenocarcinoma of lung or nonsmall cell Carcinoma, NOS diagnosis
made
performed.
BRAF mutation analysis (Assay
must be FDA approved for
this specific purpose)
MDS/FISH panel and
cytogenetic studies
AML FISH panel and
cytogenetic studies
Qualitative JAK 2 PCR and
BCR/ABL by FISH with
cytogenetic studies
Quantitative BCR/ABL test
ALK and EGFR Qualitative
testing
CBC Reflex testing
A smear review and/or manual differential (85007) will be performed when defined abnormalities are
identified. These are determined by the policies and procedures as approved by the laboratory medical
director.
S. Custom Panels and Organ and Disease Panels
A custom panel is a physician specific group of commonly ordered laboratory tests or panels which have
not been defined by the AMA or CMS that are medically necessary in treating a patient’s condition.
Baptist Health System groups certain tests together for ordering convenience. These tests bill separately.
BHS Custom Panel List
(Bold Print indicates new Panel and/or new components)
Panel #
1099
Test Listings
DIC SCREEN
85049
85610
85730
85380
85384
PROTHROMBIN TIME ( INR )
PARTIAL THROMBOPLASTIN ( PTT )
PLATELET COUNT
D DIMER TEST
FIBRINOGEN
1712
MIXING STUDY PT
85610
PROTHROMBIN TIME ( INR )
85611
PROTIME PLASMA FRACTIONS
1715
MIXING STUDY PTT
85730
PARTIAL THROMBOPLASTIN ( PTT )
85732
PTT PLASMA FRACTIONS
1084
LUPUS ANTICOAGULANT SCREEN
85610
PT
85730
PTT
85670
THROMBIN TIME
85613
85597
DRVVT RATIO
STA CLOT LA
Page 10 of 15
Pathology Interpretation
1127
IPF (IMMATURE PLATELET FRACTION)
85055
IPF%
85049
PLATELET COUNT k/ul
1128
RETICULOCYTE PANEL
RET-HE (RETIC HGB CONTENT) PG &
85046
IRF (IMMATURE RETIC FRACTION) %
85045
RETIC COUNT ul & RETIC ABSOLUTE COUNT %
2003
BACTERIAL ANTIGENS
86403
PARTICLE AGG SCREEN EA ANTIBODY
Haemophilus influenzae Grp B, Strep. pneumoniae, Strep.
Agalactiae (Strep Grp B), Neisseria meningitidis, E. coli K1.
2036
WET PREP SMEAR
Q0111
GRAM STAIN
87205
WET MOUNTS, INCLUDING PREP
2056
INTESTINAL PARASITE SCREEN
87328
CRYPTOSPORIDIUM ANTIGEN
87329
GIARDIA AG
87336
ENTAMOEBA HISTOLYTICA/DISPAR
2059
BORDETELLA PERTUSIS/PARAPERT CULT
87081
CULT, PRESUMPT PATHOGEN SCRN
2061
SMEAR CYCLOSPORA / ISOSPORA
87206
ACID FAST SMEAR
1100
CSF PROFILE
84157
82945
89051
87070
87205
2064
10812
PROTEIN OTHER FLUID
GLUCOSE BODY FLUID
CELL COUNT FLUID WITH WBC DIFFERENTAL
CULTURE ROUTINE
SMEAR FLUID GRAM (CYTOSPIN)
INFLUENZA A + B AG ( RAPID TEST)
87804
INFLUENZA A + B AG ( RAPID TEST)
RESPIRATORY PATHOGEN PANEL
87798
RSV
87502
INFLUENZA A
INFLUENZA B
87798
CORONAVIRUS
87798
PARAINFLUENZA TYPE 1
87798
PARAINFLUENZA TYPE 2
87798
PARAINFLUENZA TYPE 3
Page 11 of 15
3044
87798
87798
87798
87798
87798
PARAINFLUENZA TYPE 4
RHINOVIRUS/ENTEROVIRUS
METAPNEUMOVIRUS
ADENOVIRUS
BORDETELLA PERTUSSIS
CK MB PANEL
82550
82553
CREATINE PHOSPHOKINASE
CREATINE KINASE MB ONLY
3052
DRUGS OF ABUSE URINE
Amphetamines, Methamphetamines, Barbiturates,
G0431
Benzodiazepines, Cocaine, Methadone, Opiates, PCP THC
3068
GLUCOSE TOLERANCE TEST 2 HR
82951
GLUCOSE TOLERANCE - 3 SPECIMENS
3069
GLUCOSE TOLERANCE TEST 3 HR
82951
GLUCOSE TOLERANCE - 3 SPECIMENS
82952
GLUCOSE TOLERANCE, EACH ADDL SPEC
3070
GLUCOSE TOLERANCE TEST 4 HR
82951
GLUCOSE TOLERANCE – 3 SPECIMENS
82952
GLUCOSE TOLERANCE, EACH ADDL SPEC
3071
GLUCOSE TOLERANCE TEST 5 HR
82951
GLUCOSE TOLERANCE – 3 SPECIMENS
82952
GLUCOSE TOLERANCE, EACH ADDL SPEC
3072
GLUCOSE TOLERANCE TEST 6 HR
82951
GLUCOSE TOLERANCE - 3 SPECIMENS
82952
GLUCOSE TOLERANCE, EACH ADDL SPEC
3147
IRON PROFILE
84466
83540
TRANSFERRIN
IRON LEVEL
3190
IMMUNOGLOBULIN IGA IGG IGM
82784
IMMUNOGLOBULIN, IGA
82784
IMMUNOGLOBULIN,IGG
82784
IMMUNOGLOBULIN IGM
3197
ELECTROLYTES TIMED URINE
84132
POTASSIUM, URINE EACH
84295
SODIUM, URINE EACH
82435
CHLORIDE, URINE EACH
81050
URINE, VOLUME MEAS-TIMED SPEC
3218
SWEAT TEST
89230
82438
SWEAT COLLECTION BY IONTOPHORESIS
CHLORIDE, OTHER SOURCE
Page 12 of 15
3240
PEDI ED BASIC METABOLIC PROFILE
80051
ELECTROLYTES
82947
BUN (POINT OF CARE)
84520
GLUCOSE, POINT OF CARE,
3247
ELECTROLYTES RANDOM URINE
84133
POTASSIUM, URINE
84300
SODIUM, URINE
82436
CHLORIDE, URINE
3255
PH STOOL
83986
84376
PH FLUID
REDUCING SUBSTANCE, STOOL
3260
OPEN HEART PANEL
82495
SODIUM
84132
POTASSIUM ( K )
82330
CALCIUM IONIZED MEASURED
82947
GLUCOSE
85014
HEMATOCRIT
82803
LAB BLOOD GAS
3707
RT - CO-OXIMETRY
85018
RAPIDPOINT405 - HEMOGLOBIN
82820
RAPIDPOINT405 - HGB - O2 AFFINITY
82375
RAPIDPNT405-CARBOXYHEMOGLOBIN QNT
83050
RAPIDPOINT405 - METHEMOGLOBIN QNT
3712
RT - ABG/LYTES/GLU/CO-OX/CA++
82803
BLOOD GAS - BY RT
82330
RAPIDPOINT405 - CALCIUM, IONIZED
82947
RAPIDPOINT405 - GLUCOSE, QUANT
85018
RAPIDPOINT405 - HEMOGLOBIN
82820
RAPIDPOINT405 - HGB - O2 AFFINITY
82375
RAPIDPNT405-CARBOXYHEMOGLOBIN QNT
83050
RAPIDPOINT405 - METHEMOGLOBIN QNT
3713
RT - ABG/CO-OX
82803
85018
82820
82375
83050
BLOOD GAS - BY RT
RAPIDPOINT405 - HEMOGLOBIN
RAPIDPOINT405 - HGB - O2 AFFINITY
RAPIDPNT405-CARBOXYHEMOGLOBIN QNT
RAPIDPOINT405 - METHEMOGLOBIN QNT
3714
RT - ABG/LYTES/CA++
82803
BLOOD GAS - BY RT
82330
CALCIUM, IONIZED
3715
RT - ABG/GLU
82803
BLOOD GAS - BY RT
Page 13 of 15
82947
GLUCOSE, QUANT
3716
RT - ABG/LYTES/GLU
82803
BLOOD GAS - BY RT
82330
RAPIDPOINT405 - CALCIUM, IONIZED
82947
RAPIDPOINT405 - GLUCOSE, QUANT
4048
ANA PANEL
86038
86235
86225
ANA Screen
anti Sm (Smith) IgG, antiSM/ RNP IgG, anti SS-A IgG,
anti SS-B IgG, anti Scl-70 IgG, anti-Jo1, Anti RNP, Anti
Centromere B , Anti Chromatin , Anti Ribosomal P
Anti-dsDNA
10058
ANTICARDIOLIPIN PHOSPHOLIPID PNL
86147
CARDIOLIPIN ANTIBODIES IGG, IGM, IGA
10155
EXTRACTABLE NUCLEAR ANTIGEN, PNL
86235
anti SM IgG and anti SM/RNP
20064
TYPE + SCREEN
86900
ABO TYPE ONLY
86901
RH TYPE
86850
ANTIBODY SCREEN RBC
20069
CORD BLOOD WORKUP
86900
ABO TYPE ONLY
86901
RH TYPE
86880
DIRECT COOMBS, ANTI-IGG ONLY
20174
COOMBS DIRECT PANEL
86880
DIRECT COOMBS, ANTI-IGG ONLY
86880
DIRECT COOMBS, ANTI-POLY ONLY
86880
DIRECT COOMBS, ANTI-C3 ONLY
4055
VASCULITIS PANEL
83516
ANCA CYTOPLASMIC PR3
83516
ANCA PERINUCLEAR MPO
83516
GLOMERULAR BASEMENT MEMBRANE IgG
T. Test Substitutions/Order Clarifications
In order to clarify some commonly used abbreviations and terms, the following test substitutions will be
performed:
Commonly requested tests and resulting tests that will be performed
When a physician requests
This will be performed
Type and Cross
Type and Screen, pending order to transfuse
Liver Function Tests or LFT
Hepatic Function Panel
INR
PT/INR
CBC with diff
CBC with auto diff
BNP
B-Type Natriuretic Peptide.
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U. NEW AND REVISED CPT CODES FOR LAB AND PATHOLOGY – 2013 CODE CHANGES
Molecular codes have had numerous changes. Refer to website listed below.
The Centers for Medicare & Medicaid new tests and CPT/ HCPCS codes for 2013:
Can be found with explanation at website:
http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/ClinicalLabFeeSched/clinlab.html
http://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13CLAB.ZIP
Hit Accept at the end of the agreement
Select open on 13CLAB.
Page 15 of 15
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