Laboratory Question for the Week of May 9, 2016

Laboratory Compliance Question of the Week

Question:

What are “unrelated outpatient lab tests” that I have seen mentioned in Medicare documents?

Answer:

This is described in the Medicare Claims Processing Manual (chapter 16) as follows. 

“If the hospital provides an outpatient laboratory test (directly or under arrangement) on the same date of service as other hospital outpatient services that are clinically unrelated to the other hospital outpatient services, meaning the laboratory test is ordered by a different practitioner than the practitioner who ordered the other hospital outpatient services and for a different diagnosis than the other hospital outpatient services. Beginning July 1, 2014, report on TOB 13X with modifier L1.” 

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.