Coding Guidelines For Pathology Lab Billing Services.pptx
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1. Mercy understands that choosing a lab is about more than just
test results. It’s about aligning your practice with a laboratory that
seamlessly integrates itself within your practice and understands
your office’s laboratory needs on every level.
OUR HISTORY
It all started with a simple idea: create a lab that centers itself on
providing personalized service and support to medical providers while
completely alleviating the current billing and insurance obstacles
complicating our healthcare system.
Incorporated in 2012, Mercy Diagnostics was formed by top professionals
in the industry to oversee our clinical laboratories in order to guarantee
accurate, high quality testing in a timely manner to healthcare providers.
OUR APPROACH
Instead of the large warehouse laboratory model that predominates
the current healthcare market and requires samples to be shipped
cross-country to a main laboratory to be tested, Mercy brings highly
complex labs locally to our clients.
By building more individual local laboratories that focus only on samples
from a specific region, we can guarantee a higher level of individualized
care, quicker turn around time, increased STAT testing ability, and practically
eliminate the risk of lost or compromised samples due to longer transport.
OUR TESTING
Our state of the art analyzers not only produce highly accurate,
dependable results in rapid time, but also require significantly
less blood then our competitors resulting in a friendlier patient
sampling experience.
Our testing catalog offers over 1300 individual tests. From common
testing to specialized custom panels, we can create a menu of
tests designed around our individual practice’s needs.
Date: ______________________________________
Facility:
Address:
Phone Number:
Fax Number:
PRINT PATIENT NAME (LAST, FIRST, M.I.)
DOB
Social Security Number
Address
City
State
Zip Code
Phone Number
Insurance Self Pay Client Bill
Policy Number
Physician's Name
Physician's Signature
Phlebotomist/Nurse
Draw Time
Circle One
AM / PM
Copy Results To:
1) Please check the box to the left of each test that is being ordered and include an ICD-9 code for all tests as a requirement
Fax Number:
2) To order any test that is not listed, please write it in the "other tests" section along with an ICD-9 code
3) Specimens must be clearly marked with two identifiers (ie, name and date of birth) in order to be processed.
TUBE
ICD-9
TUBE
ICD-9
TUBE
ICD-9
Basic Metabolic Panel
SST
Albumin
SST
Mumps Ab, IgG
SST
Comprehensive Metabolic Panel
SST
Alkaline Phosphatase
SST
Phosphorus
SST
Electrolyte Panel
SST
ALT (SGPT)
SST
Potassium
SST
Hepatitis Panel (Acute)
SST
Ammonia **
Green **
Progesterone
SST
Liver Profile (Hepatic)
SST
Amylase
SST
Prolactin
SST
Lipid Panel
SST
ANA Screen
SST
Protein, Total
SST
Renal Funtion Panel
SST
AST (SGOT)
SST
PSA
SST
Thyroid Panel
SST
Bilirubin, Direct (Dbil)
SST
Rheumatoid Factor (RF)
SST
TUBE
ICD-9
Bilirubin, Total (Tbil)
SST
Rubella Immune Status
SST
PT w/ INR
Lt Blue
B-Type Natriuretic Peptide (BNP)
Lavender
Serum Protien Electrophoresis SST
PT/PTT
Lt Blue
BUN
SST
Sodium
SST
PTT
Lt Blue
C-Peptide
SST
T3, Free (Triiodothyronine)
SST
TUBE
ICD-9
C-Reactive Protein, hs
SST
T3, Total
SST
CBC
Lavender
C-Reactive Protein Inflammation
SST
T3 Uptake
SST
CBC w/ Diff
Lavender
C3,C4**
SST**
T4, Free (Thyroxine)
SST
Hematocrit
Lavender
CA-125
SST
T4, Total
SST
Hemoglobin
Lavender
Calcium
SST
Testosterone, Free & Total
SST
Hemoglobin/Hematocrit
Lavender
Calcium, Ionized
SST
Testosterone, Total
SST
Platelet Count
Lavender
CEA
SST
TSH
SST
Reticulocyte Count
Lavender
Chloride
SST
Uric Acid
SST
Sedimentation Rate (ESR)
Lavender
Cholesterol, Total
SST
Valproic Acid (Depakote)
Red
TUBE
ICD-9
Creatinine
SST
Varicella Zoster Ab, IgG
SST
Hep B Surface Antibody (Immunity)
SST
Creatine Kinase (CPK)
SST
Vitamin B12
SST
Hep B Surface Antigen
SST
Cortisol
SST
Vitamin D 25-Hydroxy
SST
Hep C Antibody
SST
Digoxin (Lanoxin)
Red
HIV 1/2 Screen
SST
Dilantin (Phenytoin)
Red
HSV 1/2 Screen
SST
Estradiol
SST
Treponema w/ reflex to RPR
SST
Ferritin
SST
TUBE
ICD-9
Folate
SST
Blood Culture
Bottles
FSH
SST
C. Difficile Culture- Para Pak
White
GGT
SST
Genital Culture
Cx Swab
Glucose, Serum
SST
Nasopharyngeal Culture
Orange Cx Swab
Glucose Tolerance ____________hrs SST
Occult Blood X ______
Sterile Cup
H-Pylori Qualitative
Lavender
Ova & Parasites - Para Pak
Blue & Pink
HgbA1C
Lavender
1. Source: ____________L R
Strep Culture, Group A
Blue Cx Swab
hCG, Qualitative - Pregnancy
SST
Clinical Hx: ____________________
Strep Culture, Group B
Blue Cx Swab
hCG, Quantitative
SST
2. Source: ____________L R
Sputum Culture
Sterile Cup
Homocysteine
SST
Stool Culture - Para Pak
Orange
Insulin
SST
Throat Culture
Blue Cx Swab
Intact-PTH
SST
Urine Cx Cath____ Clean Catch____
C&S Tube
Iron
SST
Pap Test: □ThinPrep □SurePath
Wound Culture
Blue Cx Swab
Lead
Royal Blue
□reflex to HPV □auto HPV
Source ________________
LH (Luteinizing Hormone)
SST
□GC/Chlamydia
TUBE
ICD-9
Lipase
SST
Total Volume: _______________
Lithium
SST
24-hr Urine, Creatinine Clearance
24 hr container
Lyme Antibody, Total
SST
Urinalysis, Complete
Sterile Cup
Magnesium
SST
Urinalysis with reflex to Urine Cx
Cup/C&S Tube
Measles Ab, IgG
SST
Urine, Chlamydia & Gonorrhoeae
Sterile Cup
Mono Screen
Lavender
Urine, Drug Screen
Sterile Cup
Urine, Microalbumin Creatinine Ratio
Sterile Cup
Urine, Random Creatinine
Sterile Cup
Urine, Random Na, K, Cl
Sterile Cup
Urine, Random Protein
Sterile Cup
Edition 03.01.2015
PANELS
COAGULATION
HEMATOLOGY
INFECTIOUS DISEASES
Previous Bx: ___________________
PATHOLOGY
URINE TESTS
ALPHABETICAL (cont)
ALPHABETICAL
MICROBIOLOGY
OTHER
** TESTS - CRITICAL FROZEN. POUR OFF SERUM OR PLASMA INTO A SEPARATE CONTAINER. FREEZE IMMEDIATELY.
TRANSPORT IN FROZEN SPECIMEN CONTAINER.**
SEX
Purpose: ______________________
Source: ________________________
ICD-9
For any patient or payor (including Medicare and Medicaid) that has a medical necessity requirement, you should only order those tests which are medically necessary for the diagnosis and treatment of the
patient.
PATIENT INFORMATION
* PLEASE ATTACH COPIES OF THE FRONT/BACK OF
INSURANCE CARD
ORDER INFORMATION
SERUM SEPARATOR TUBES & RED TOPS - REQUIRE TO BE SPUN DOWN AND SEPARATED FROM CELLS IMMEDIATELY
LMP: __________________________
Previous Pap: __________________Clinical Information
GYNECOLOGICAL PATHOLOGYClinical Hx: ____________________
* Full name and fax number required for copying results*
LAB REQUISITION
Phone: 877.514.5504 - Fax: 856.874.4399
Fasting / Non Fasting
BILLING POLICIES
Below you will find an example of a document that your insurance company may send you. This is an explanation
of benefits that explains the insurance claim for the laboratory services Mercy Diagnostics performed. THIS IS NOT
A BILL. Please read the document carefully as each insurance company has their own unique format.
THE EXPLANATION OF BENEFITS FROM YOUR INSURANCE COMPANY IS NOT A BILL
THIS IS NOT A BILL
You DO NOT pay the amount the
insurer says is the patient
responsibility; DO NOT PAY THIS.
YOU MAY RECEIVE A CHECK FROM YOUR INSURANCE COMPANY
Your insurance company may send payment directly to you for services
provided by Mercy Diagnostics. In such cases you are expected to forward the
check directly to Mercy Diagnostics.
Please sign the back of the check and write “Pay to the Order of Mercy
Diagnostics” as shown to the right and forward the check and any EOB to:
Mercy Diagnostics
Attention: Billing Department
3109 Poplarwood Ct 302
Raleigh, NC 27604
Pay to the Order of
Mercy Diagnostics
Your Signature Here
Mercy Diagnostics services are separate from your doctor’s office and are billed independently
QUESTIONS? Please Call Patient Financial Services 856-437-5245, Monday-Friday 8am-5pm
Mercy Diagnostics, Inc. ● 1-877-514-5504 ● www.mercydiagnostics.com
MEDICARE & MEDICAID
Plan participants are liable for deductibles, coinsurance and copays. Mercy Diagnostics will bill patients for
amounts due.
ALL OTHER INSURANCES
For all other insurance plans, Mercy Diagnostics will file a claim for your laboratory services.
If the insurance company does not cover testing due to Mercy Diagnostics being a
“Non-Preferred Provider”, Mercy Diagnostics will assume all the risk.
Mercy Diagnostics will accept payment from your insurance company as payment in full.
CHEMISTRY & ENDOCRINOLOGY
TEST
CPT CODE CLIENT PRICE SELF-PAY PRICE
Albumin
82040
$0.45
$6.75
Alkaline Phosphatase
84075
$0.45
$7.06
ALT
84460
$0.45
$7.22
Amylase
82150
$0.45
$8.84
AST
84450
$0.45
$7.06
Bilirubin - Direct/Indirect
82248
$0.45
$6.84
BMP
80048
$0.95
$11.54
BNP
83880
$20.00
$46.31
BUN
84520
$0.45
$5.39
C-Reactive Protein (hs)
86141
$8.00
$17.66
C-Reactive Protein (Inflammation) 86140
$3.75
$7.06
CA 125
86304
$4.50
$28.39
Calcium
82310
$0.45
$7.04
Carbon Dioxide
82374
$0.45
$6.67
Chloride
82435
$0.45
$6.27
Cholesterol Total
82465
$1.45
$5.93
CMP
80053
$1.95
$14.41
Cortisol
82533
$2.25
$22.24
Creatine Kinase
82550
$1.95
$8.88
Creatinine
82565
$0.45
$6.99
Electrolyte Panel
80051
$1.95
$9.57
Estradiol
82670
$1.95
$38.12
Ferritin
82728
$4.14
$18.59
Folate
82746
$4.50
$20.06
Free T3
84481
$1.95
$23.11
Free T4
84439
$1.95
$12.30
FSH
83001
$2.50
$25.35
GGT
82977
$0.45
$9.82
Glucose
82947
$0.45
$5.36
HCG (Qual & Quant)
84702
$1.95
$20.54
FEE SCHEDULE
IT SOLUTIONS
Phone: +1-877-514-5504
Email: support@mercydiagnostics.com
Phone: +1-877-514-5504
Email: support@mercydiagnostics.com
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