Laboratory Question for the Week of April 18, 2016

Laboratory Compliance Question of the Week

Question:

I know that CMS expanded Medicare packaging to include lab tests that are reported on the same claim with a primary service, regardless of the DOS. But I don’t know how to bill for overnight stays, such as a late arrival in ED etc.

Answer:

You are correct that packaging has been expanded to include lab tests that are reported on the same claim with a primary service, regardless of the date of service (DOS). As we understand it, this applies to preoperative testing connected with a surgical procedure and also for the services that cross over the midnight hour, such as an emergency department (ED) visit where a patient comes in late at night and lab services are requested after midnight. CMS is not necessarily looking for the same calendar date; it’s a matter of all outpatient services appearing on the same claim for the same encounter. For example, observation stays might cross over one or two calendar days. Depending on how well utilization is managing the outpatient services, it may extend over several calendar days. All laboratory procedures provided during the “to and from” dates of the encounter and identified as packaged (Q4) will be included in the payment for the primary service.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.