Pathology/Lab Coding Alert

Medicare will pay for trips to nursing homes or homebound patients. If the cost of fuel is eating up your reimbursement when your personnel travel to homes or nursing homes to take samples for lab tests, Medicare has a solution. CMS Transmittal 1524, effective June 30, reminds labs that Medicare allows payment for "estimated travel costs of collecting the specimen." You can collect a flat rate or a mileage-basis rate -- look at the following tips to learn how. Report Miles if More Than 20 For trips greater than 20 miles, you should bill the service based on the actual miles that the lab tech travels . Mileage basis: To bill using the per-mile travel allowance, report P9603 (Travel allowance, one way in connection with lab specimen collection), which Medicare pays at $0.955 cents per mile. "You can use this code if you travel longer than 20 miles round trip," says Tina Landskroener, CMBS-I, CCS-P, CPC, office manager with Blessing Physician Services, during the June 25 Coding Institute audioconference, "Critical NCCI Update for Third Quarter 2008," (http://www.audioeducator.com). "Payment using P9603 is prorated if you pick up any non-Medicare specimens along the way," Landskroener says. Example: Suppose your lab technician travels 60 miles round-trip from the lab in the city to a remote rural location and back to the lab to draw a single Medicare patient's blood. The total reimbursement would be $57.30, which is the 60 miles times the $0.955 cents per mile, Landskroener says. In addition, you also can charge for the specimen collection fees. Use Flat Rate for Shorter Trips If the lab technician travels fewer than 20 miles, you-ll have to use a different code to report the service. Flat rate: The alternative code for shorter trips is P9604 (Travel allowance, one way in connection with a lab specimen collection). Listing this code means you-ll collect the flat rate trip payment of $9.55 for each one-way trip. Red flag: The lab specimen collection must be the only service that your lab tech is performing if you want to collect the travel allowance, Landskroener says. If you-re taking a blood pressure or doing any other assessments, then you can't bill for the travel. Round trip: For round trip travel, append modifier LR (Laboratory round trip) to either P9603 or P9604, Landskroener advises. To read the entire MLN Matters article, go to http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5996.pdf.