Wiki Non-covered lab charges

[ashleemh92]

I have the toughest time trying to figure out what labs have certain diagnoses that are covered, and which ones don't have a policy. I'm starting to notice a trend in which labs always get denied even though they do have a covered dx. For me personally these are the most used.
lipid 80061- E78.5 hyperlipidemia
Nat peptide 83880- I50.32 CHF
TSH 84443- E03.9 hypothyroidism

The labs I have the biggest problems with are
80048 PR BASIC METABOLIC PANEL CALCIUM TOTAL
82607 PR CYANOCOBALAMIN VITAMIN B-12
84550 PR ASSAY OF BLOOD/URIC ACID
85027 PR BLOOD COUNT COMPLETE AUTOMATED

Does anyone have any tips or advice for me to make these easier to navigate. I know I can find the policies but sometimes that's so much to look through also.

 

[Pam Warren]

It depends on the payer, but CMS and the commercial payers all have coverage policies. I know they're 'so much to look through', but that's the business of medicine.

Overall, though, we should be coding based on the physician's order, and educating him/her on payer requirements. Medicare will not cover routine lab work, and you would be expected to issue an ABN or notice of non-coverage.

My advice is to learn those coverage policies. Otherwise, you will struggle.