Author Topic: Lab CPT codes  (Read 1661 times)

DMK

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Lab CPT codes
« on: February 05, 2014, 11:59:42 AM »
Here's an interesting conundrum that we're running into with many of our patients.  They are going for lab testing for hormone imbalances with a company that's a cash practice.  They are a company that promotes anti-aging protocols (low t, gluten free, etc.).

The patient goes and gets a lengthy blood test (and they test everything....) prior to the appointment.  They pay the company a flat rate.  Then they pay the doctor at time of service for his opinion once the test is done.

So here's the problem..... the patient gets the blood test done, then finds out they have to have surgery for something unrelated so they don't get in right away for the hormone evaluation.  They want to recoup the lab fees from their insurance.  They got an itemized statement from the company, but it did not have the CPT codes it had the labs particular contract codes. 

Don't providers HAVE to give the patient a valid bill with CPT codes REGARDLESS if they only take cash?

If no, can the patient find the codes and submit the bill?

I'd love to be able to answer this question!

PMRNC

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Re: Lab CPT codes
« Reply #1 on: February 05, 2014, 12:07:35 PM »
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Don't providers HAVE to give the patient a valid bill with CPT codes REGARDLESS if they only take cash?

Yes, I would imagine they would.. I would have patient argue with them though. Is it possible they provide tests that are never covered maybe even don't have codes? Just a guess, not sure. I've done hormonal testing but I've had  my insurance pay it regardless.

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If no, can the patient find the codes and submit the bill?

Absolutely, positively NOT. What they can do is call their insurance carrier and tell them they are unable to obtain an itemized bill from the facility.

 
Linda Walker
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Merry

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Re: Lab CPT codes
« Reply #2 on: February 05, 2014, 07:58:36 PM »
When it is a cash only issue, I doubt if there are laws regarding giving out the CPT codes. I would find out who oversees the labs in your state and give them a call. Is this lab certified? And by whom? I would call the entity that certifies them but would definitely call a state agency.
« Last Edit: February 15, 2014, 01:52:48 AM by Merry »

DMK

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Re: Lab CPT codes
« Reply #3 on: February 06, 2014, 11:03:35 AM »
It's Quest.  They are big in this area.  We use them ourselves.  But they have a "contract" with the MD clinic.  I can pull the codes, but I wanted to know the legalities.

Michele

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Re: Lab CPT codes
« Reply #4 on: February 06, 2014, 11:07:30 AM »
I am seeing these pop up more and more.  These labs that charge big bucks to do a huge slew of tests for patients.  It's more because patients want them than they are being ordered.  Patients pay up front and then try to get reimbursement.

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PMRNC

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Re: Lab CPT codes
« Reply #5 on: February 06, 2014, 12:54:03 PM »
But still.. they are required to produce itemized bills.. appropriate CPT codes as well. The patient of course is responsible for filing to their insurance carriers. The only difference is that the lab doesn't have to go beyond giving you the proper itemized bills.
Linda Walker
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DMK

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Re: Lab CPT codes
« Reply #6 on: February 06, 2014, 01:01:52 PM »
There's the sticky problem.  If it was just Quest, it wouldn't be an issue.  But Quest has a contract with the clinic (I'm sure they're giving them a special rate) it's the clinic that won't give the patient the codes.  Grrr.

PMRNC

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Re: Lab CPT codes
« Reply #7 on: February 06, 2014, 02:07:15 PM »
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it's the clinic that won't give the patient the codes.  Grrr.

As in the place where the labs are being drawn?  If so how is patient paying this?
Linda Walker
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DMK

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Re: Lab CPT codes
« Reply #8 on: February 07, 2014, 10:39:52 AM »
The blood was drawn at Quest with an order from BodyLogic.  The payment went to BodyLogic.  An itemized statement was requested from BodyLogic.  It came with no CPT codes.

PMRNC

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Re: Lab CPT codes
« Reply #9 on: February 07, 2014, 11:14:38 AM »
The blood was drawn at Quest with an order from BodyLogic.  The payment went to BodyLogic.  An itemized statement was requested from BodyLogic.  It came with no CPT codes.

So Quest drew the blood. Patient is paying BodyLogic at time of service, what I'm confused about is how BodyLogic can charge for services they are not rendering? If they are not drawing blook and only ordering it, I fail to see how they can bill the patient.. QUEST should be billing someone... no?
Linda Walker
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