Wiki In-House Labs and Outsourced Labs

[mdnewsome]

We have some providers who will order an in-house lab test such as 85025 and then when they get the results they determine they need more details from the test therefore they will order the same test through our outside lab-quest diagnostics. Quest will also bill for this same lab test. Is there any modifiers that could be used on our claim so that we could also be paid? Basically quest is billing for the test immediately and then by the time our claims gets billed--they deny our lab test as a duplicate. We were just wondering if it is acceptable to bill the same test both in-house and via quest? They did order the test twice and both tests were done. Any information anyone has on this would be helpful. Thank you.

 

[csperoni]

I'm trying to understand the medical necessity of this, which is the overarching criteria for all services. If your in-house lab requires the same exact testing to be repeated on the same specimen, this seems "suspicious."
If your in-house labs are not providing reliable results, I would question why they are being performed and/or billed.
If your in-house lab is not performing all the elements of 85025 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count, then you may be billing the incorrect CPT. I know one of my sites performs just a hemoglobin blood count, and then sends out for full testing if needed.
If there was a problem with the specimen itself and re-draw was needed with a test on a new specimen, you may want to look at modifier -91, but this is not my area of expertise.

 

[klapetri@ilovemygyn.com]

We perform the following tests at our in-office location (Location One), where the patient is seen and the specimen is collected. The specimen is then sent to our in-house laboratory located at a separate office (Location Two), where the tests are processed and resulted.

We are receiving denials from UnitedHealthcare only, citing issues related to the CLIA number.
Question:
Which CLIA number should be reported on the claim — the one for the specimen collection site (Location One) or the one for the performing lab (Location Two)?

Tests performed
87491, 87591, 87661, 87481, 87801, 81513, 87563, 87624, 87625, 87653, 82670, 84144, 84443, 84439, 83001, 83002, 82627, 84403, 84146, 84270, 84702, 82306

We would appreciate clarification to ensure proper billing and avoid future denials- Thank you!