# Lab Orders... am I totally wrong here?



## ohn0disaster (Nov 11, 2010)

My doctors see a lot of patients that are on some type of anticoagulant. We do PTs monthly on these patients but our doctors rarely write orders for the labs. I needed to know how often they have to have these orders in their notes. I tried to explain to my administrator that the doctor writing "PT monthly" once a year isn't good enough. She wants to send our billing department notes from months prior, when the patient has been in various times since to see the doctor, because that's the last time he mentioned anything about it.

I told her that he can just add an addendum to his last note, which was a few days prior to the PT lab. She just looked at me like I was annoying her.... Lol. I know you can use the note to show the orders for a certain amount of time but how long is that certain amount of time? Where do I find something in writing to prove that I'm not an idiot? Or am I an idiot and I'm completely wrong on this? It just seems to me like, if I go to the doctor in January of 2010 and the doctor writes an order for PT monthly at that time, that order shouldn't last forever....


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## ohn0disaster (Nov 12, 2010)

Any information that I can be pointed to? Someone? Anyone?


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## Anna Weaver (Nov 12, 2010)

I would check out CMS in the lab manual section. We always allow the "standing" orders for one year. But, they had to be dated, signed, patient name and date of birth, diagnosis, test, and how often (every month, wk, etc) in order for them to be valid. then if it ran out, we would contact the office and let them know or when the patient came in we would tell them they needed a new order the next time they came in. I know there's regs out there, just don't know right off where to find it. Sorry can't be more help here. Anyone else?


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## cmcgarry (Nov 12, 2010)

Vanessa, do you perform and bill the labs or are they sent to an outside lab?  If outside, I would check with that lab to see what their requirements are for "standing orders".  Most are only good for one year, and must contain the diagnosis and the frequency.  When I worked in a clinic with a number of anticoagulation patients, we did not see them prior to each PT test - they quite often went directly to the lab.  If you have your own lab and bill these out, I would suggest having a policy in place; if you have that, and that the lab order is good for one year, you would have documentation in case of audit.

Hope that helps,


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## ohn0disaster (Nov 12, 2010)

The patients will come here for the draw and then we send it out to LabCorp. We definitely do not see the patients before every PT is done BUT the patients do come in somewhat regularly, about every 2 - 3 months. The reason that I'm seeing a problem with it is that there is no written orders on the follow-up visits. No "Patient still on Coumadin. Will continue to do monthly PT/INR.", in fact they rarely mention ANYTHING about it at all. To me it looks like a bunch of repeat labs with no documented medical necessity. We send our coded encounters to the billing department and they are constantly asking for the doctor's orders for the labs so that they can be billed. I was just wondering if the doctor writes "we will continue monitoring PT monthly", how often we have to document this? Once a year is good?


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## annielou (Nov 23, 2010)

If the doctor has signed a standing order for the lab, it is good for one year. Although it would be "good medicine" if the doctor mentioned the PTs in the OV notes, it is not necessary. It is necessary for him to sign off on each PT result in the patient's chart.


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## Lisarae1970 (Dec 2, 2010)

At our Oncology/Hematolgy clinic, standing orders for PT/INR are valid for 12 months. They must include frequency, medically nec. diagnosis,  patient identification, and MD signature.

*And no, your suspicion certainly doesn't make you an idiot!~I would agree with annielou that "good medicine" should be applied by the physician.


Lisa Bates
CPC
Oncology/Hematology


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## RebeccaWoodward* (Dec 2, 2010)

Page 6 offers some guidance.

*"4. Reliance on Standing Orders"*

http://oig.hhs.gov/authorities/docs/cpglab.pdf


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