Annual Laboratory Notice to Physicians

Dear Physician:  

In our ongoing efforts to improve the efficiency of our lab as well as the quality of your experiences with our lab, we have drafted this annual notice to provide you and your staff with some basic, yet significant, information. We hope that you and your staff find this information helpful and thank you in advance for your cooperation in adhering to our Laboratory Compliance requirements.  

Laboratory Leadership  

·         Medical Laboratory Director:: Dr. Richard Wells 
            o   Phone 256-543-5249  

·         Administrative Laboratory Director: Elizabeth Waller MT(ASCP)
o   Phone 256-543-5782
o   Fax 256-546-9276
o   Cell 256-490-8274  

·      Point of Care Coordinator: Jo Wyatt MT(ASCP)
o   Phone 256-543-5247  

·      Reference Lab/Phlebotomy Supervisor: Vester “Dee” Ledbetter MT(AMT)
o   Phone 256-543-5250
o   Phone 256-543-5798  

·      Blood Bank Section Head: Terry Williams MT(AMT)
o   Phone 256-543-5251  

·      Chemistry Section Head: Patsy Gooch MT(ASCP)
o   Phone 256-543-5254  

·      Histology/Pathology Section Head: Michelle  Stovall MLT(ASCP)
o   Phone 256-543-5248  

·      Hematology/Coagulation Section Head: Patsy Kendrick MT(ASCP)
o   Phone 256-543-5255  

·         Microbiology/Serology/Urinalysis Section Head:
o   Phone 256-543-5258  

·      Main Laboratory
o   Phone 256-543-5250
o   Fax 256-546-9276  

·      Bay Street Lab (Medical Arts Building)
o   Phone 256-546-4793  

·      Pathology Transcriptionist/Secretary: Nancy Smith
o  Phone 256-543-5253
o  Fax 256-543-5456    

Medical Necessity  

The federal government will only pay for tests that are covered, reasonable, and medically necessary given the patient’s clinical condition. Since labs do not treat patients, or make medical necessity decisions, it is important that the Physician, or other authorized individuals, ordering lab tests make an independent medical necessity decision on each lab test ordered and submit diagnosis information for each test ordered.  

Lab Requisition Form (attachment “A”)  

Attached please find a copy of the hospital’s lab requisition form. The form sets forth the tests available at our lab and has been designed to capture the necessary information required by federal and private healthcare programs as well as to promote conscious ordering of tests. The information that you submit on the lab requisition form or other approved order form must accurately reflect the medical reasons for requesting the specified tests. In addition, the medical necessity and order for each of the individual tests you order must be appropriately documented in the patient’s medical record. If the necessary information is not provided or otherwise not clear, such as a diagnosis, then the hospital staff will contact the physician or other authorized person.  

We strongly encourage all physicians to use the hospital lab requisition form each time that you order a test from the lab.  

Organ and Disease Panels  

Medicare has a list of organ and disease related panels that are acceptable and chargeable to Medicare only when all components are medically necessary. Some tests in these panels may be subsets of other panels and may not be ordered together or on the same date of service. In addition, it is not appropriate to order the components of a panel individually.   

Local Medical Review Policies (“LMRP’s) and Local Coverage Determinations (“LCD’s) (attachment “B”)  

LMRP’s and LCD’s relate to a Medicare Carrier’s (Payor) decision when and under what circumstances a service will be considered covered, reasonable and necessary, and what documentation will support the need for the service. Attached is an index of LMRP’s, the full text of the LMRP’s can be found at www.mutualmedicare.com.    

The hospital has installed software that is designed to screen tests to determine if they are reasonable and necessary in accordance with the relevant LMRP’s. The software compares the patient’s diagnosis and ordered test(s) with the LMRPs to verify coverage. If the physician has failed to provide diagnostic information or has only provided a narrative diagnosis that is not easily identifiable with an ICD-9 code, the physician, or other authorized person, will be contacted for the information.  

Advance Beneficiary Notices (“ABN’s) (attachment “C”)  

If a test is determined to not be reasonable and necessary, the patient will be required to sign an ABN. An ABN is a notice to a patient that the government may not pay for the test(s) and that the patient may be personally responsible for the cost of the test(s). If the patient does not sign the ABN, the lab may choose not to perform the test(s). We encourage you to print the LMRP’s that relate to tests you order and familiarize yourself with pertinent information.  

If you order a test(s) for a patient that requires an ABN, please present the patient with the ABN form, explain that the ordered test may not be covered, and have the patient fill out the ABN at your office prior to sending the patient and/or a specimen to the hospital. If the patient brings a signed ABN, or a signed ABN is provided with the specimen, this will significantly expedite our process as well as reduce any inconvenience to you or your patients.  

Customized Profiles  

Each test in a customized profile must be covered, reasonable, and necessary, otherwise Medicare will not pay for the test and an ABN will be necessary.  

Approved Laboratory Testing Panels  

The American Medical Association (AMA) has approved eight Organ or Disease Oriented Panels. The tests listed in each panel identify the defined components of that panel. These panel components are not intended to limit the performance of other tests. If a test is ordered in addition to those specifically indicated for a particular panel, that test will be reported separately, conversely, if a test is a part of the panel, please do not order that test separately.

The attached table is organized to show the organ/disease oriented panels and all the individual chemistry tests associated with that panel:      

CPT Code

Approved Panel

CPT Code

Approved Panel

80047

Basic Metabolic Panel (Calcium, ionized):

80061

Lipid Panel:

Calcium (82330)

Cholesterol, serum, total (82465)

Carbon dioxide (82374)

Lipoprotein, direct measurement, high density cholesterol – HDL Cholesterol (83718)

Chloride (82435)

Triglycerides (84478)

Creatinine (82565)

80069

Renal Function Panel:

Glucose (82947)

Albumin (82040)

Potassium (84132)

Calcium (82310

Sodium (84295)

Carbon dioxide –bicarbonate (82374)

Urea Nitrogen – BUN (84520)

Chloride (82435)

(Do not use 80047 in addition to 80053)

Creatinine (82565

80048

Basic Metabolic Panel (Calcium, total):

Glucose (82947)

Calcium (82310)

Phosphorus inorganic – phosphate (84100)

Carbon dioxide (82374)

Potassium (84132)

Chloride (82435)

Sodium (84295)

Creatinine (82565)

Urea Nitrogen – BUN (84520)

Glucose (82947)

80074

Acute Hepatitis Panel:

Potassium (84132)

Hepatitis A antibody- HAAb, IgM antibody (86709

Sodium (84295)

Hepatitis B core antibody- HBcAb, IgM antibody (86705)

Urea Nitrogen – BUN (84520)

Hepatitis B surface antibody- HBsAg (87340)

(Do not use 80048 in addition to 80053)

Hepatitis C antibody (86803)

80051

Electrolyte Panel:

80076

Hepatitis Function Panel:

Carbon dioxide (82374)

Albumin (82040)

Chloride (82435)

Bilirubin, total (82247)

Potassium (84132)

Bilirubin, direct (82248)

Sodium (84295)

Phosphatase, alkaline (84075)

80053

Comprehensive Metabolic Panel:

Protein, total (84155)

Albumin (82040)

Transferase, alanine amino – ALT or SGPT (84460)

Bilirubin , Total (82247)

Transferase, aspartate amino – AST or SGOT (84450)

Calcium (82310

(Do not use 80076 in addition to 80053)

Carbon dioxide –bicarbonate (82374)

Chloride (82435)

Creatinine (82565

Glucose (82947)

Phosphatase, alkaline (84075)

Potassium (84132)

Sodium (84295)

Transferase, alanine amino – ALT or SGPT (84460)

Transferase, aspartate amino – AST or SGOT (84450)

Urea Nitrogen – BUN (84520)

Do not use 80053 in addition to 80048, 80076

 

 

 
Standing Orders  

The hospital will allow the use of standing orders when executed in connection with an extended course of treatment and written for a fixed period of time, not to exceed one year.

These standing orders will require periodic review every 90 days by the ordering physician to verify continued medical necessity.  

Reflex Testing  

Reflex testing occurs when initial test results are positive or outside normal parameters and indicate that a second related test is medically appropriate. It is the policy of this facility to only perform reflex testing when indicated with the physician’s original order, in a new physician order, or pursuant to the laboratory policy on reflex testing as approved by the Hospital Medical Staff. Physicians must provide a written order if they want to override reflex testing performed pursuant to the written lab policy. Any questions please contact the laboratory for further information.  

Legal  

As part of this notice to physicians, the Office of Inspector General (OIG) has requested that we inform all ordering physicians that they take the position that an individual who knowingly causes a false claim to be submitted may be subject to sanctions or other remedies available under civil, criminal, and administrative law.  

We realize that you have choices and appreciate that you have chosen to use Riverview Regional Medical Center Laboratory. If you have any questions or comments, please do not hesitate to call.      

Sincerely,      

Laboratory Medical Director                                      Laboratory Director
Dr. Richard Wells                                                       Elizabeth Waller MT(ASCP)