Wiki lab tests billing

[suvarna]

Hi, I work for op department in a hospital. patient presented c/o uncontrolled HTN and family history of diabetes . doctor ordered ECG,NA, K,CREATININE , URIC ACID, AND LIPID PROFILE . My question is will all these tests will be justified with uncontrolled HTN Dx.
kindly suggest how to bill these tests to the insurance. Thanks in advance.

 

[Kristen Bensel]

It usually depends on what the insurance is. If it is a Medicare patient, then Medicare has some tests that it deems require medical necessity. However, most commercial insurances do not break each one down like that. I would think from my past experience billing labs that as long as it isn't Medicare then it should be fine with the HTN diagnosis. And if insurance denies then it would most likely be because the patients plan, not the diagnosis.
You also mentioned though that you are in a OP department... so did the provider need the ECG and tests for a Pre-operative screening?