Duplicate lab tests performed on the same DOS ordered by different providers
We are seeing same lab tests ordered by different providers and completed. How do you code and bill for these, especially for commercial payers? Found conflicting information- use modifiers, delete the duplicate charge, leave duplicate charge as is and appeal...
Sign In to comment.
Comments
Were both providers unaware that the other ordered the test? The lab should have a process in place to identify duplicate tests and tests that are included in a panel. If a panel is ordered and reported and then later, i.e hours later, a single test - or more, are repeated - medically necessary - then a modifier is appropriate.
If somehow, two physicians ordered the same tests or subparts of the same test, i.e. CMP and another physician ordered electrolytes, there is no medical necessity for both.
Your option is to not bill for the electrolytes because it wasn't medically necessary since the results were available within the CMP during the same timeframe, OR
Charge for both and bill the electrolytes as noncovered.
Both options have the same end result - no payment for the second or included test.
The decision point is before the test has been performed. The order for the repeat or included test should trigger a question before the lab is even drawn.