Laboratory Question for the Week of December 17, 2018

Question:

The recommended practice is to confirm a new patient’s blood type with a repeat blood draw and retype done on the new specimen. This is only for a new patient or a patient who does not have type information already in the system. Is it appropriate to bill for the second blood type on a new patient, or is this considered confirmatory testing?

Answer:

Based on the information provided, it does not appear the second blood type may be coded and billed. Modifier 91 may be used to report repeat testing when the physician has documented the rationale for an additional test.

The Medicare Claims Processing Manual (MCPM) and the National Correct Coding Initiative (CCI) Policy Manual for Medicare Services address repeat testing, which must be medically reasonable and necessary.

Based on information in the MCPM, Chapter 16, Section 100.5.1, the repeat testing cannot be performed to “confirm initial results; due to testing problems with specimens and equipment; or for any other reason when a normal, one-time, reportable result is all that is required.”

The National CCI Policy Manual further states, “As another example, if a patient has an abnormal test result and repeat performance of the test is done to verify the result, the test is reported as one (1) unit of service rather than two (2).”

This question was answered in an edition of our Laboratory Compliance Manager. For more hot topics relating to laboratory services, please visit our store or call us at 1.800.252.1578, ext. 2.