Coding > Coding

Lab CPT codes

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DMK:
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:

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

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.


--- Quote ---If no, can the patient find the codes and submit the bill?
--- End quote ---

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.

 

Merry:
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.

DMK:
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:
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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