Wiki Saliva and ALCAT kits

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amyj.howe

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I've recently acquired a new physician that provides ALCAT and Saliva kits to patients. These patients complete the kits at home and mail to the respective labs. The labs then process the kits and send the report to the doctor for review. The current practice of this doctor is to bill the lab/path codes for reimbursement of these kits. I instantly thought this can't be correct however not ever having done lab billing wanted to be perfectly clear that this was not the appropriate method for billing these kits. Any insight as to how these kits, not the processing of the kits, should be billed would be greatly appreciated!
 
amyj.howe said:
I've recently acquired a new physician that provides ALCAT and Saliva kits to patients. These patients complete the kits at home and mail to the respective labs. The labs then process the kits and send the report to the doctor for review. The current practice of this doctor is to bill the lab/path codes for reimbursement of these kits. I instantly thought this can't be correct however not ever having done lab billing wanted to be perfectly clear that this was not the appropriate method for billing these kits. Any insight as to how these kits, not the processing of the kits, should be billed would be greatly appreciated!
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I only code paths and labs and if someone else is processing the results, I can only assume they are billing you for their leg work (please be sure and check who is billing who). Then you in return would bill the patient for the services rendered. I know that there are patients that get care packages that we have to draw blood or otherwise and seal the package and send out and at that point we charge a handling charge for that service. I don't know if your place of business does ~ but check.
I hope this helps,
Dana Chock, CPC-A, CCA
 
There is no confusion as to who is doing what and who is billing for what, my concern is whether or not the current practice is legal/correct. My doctor is billing for lab work completed elsewhere and reimbursing the lab for services rendered. I consider this fraudulent in that she is billing for a service that she did not provide. It's quite likely this is done because of contracting with the lab etc and it makes it easier to obtain payment from health plans, but that doesn't necessarily make it correct. Does that make sense?
 
Check the -90 modifier. We use this modifier to indicate the test was purchased. It sounds as though this modifier would be applicable to your coding scenario.
(the lab should not be billing the codes, since there is an agreement that the doctor is paying the lab directly.)
 
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