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POC creatinine testing prior to CT imaging

Charlene Posted Thu 21st of February, 2019 08:35:07 AM
Our facility (physicians office) now offers CT imaging. Can we bill for POC creatinine testing? Does there need to be an order for this, and does it need to be on the CT order? Based on the criteria for testing, what diagnosis(es) would be best, and does that diagnosis set need to be on the order as well?
SuperCoder Answered Fri 22nd of February, 2019 02:10:50 AM

Hi,

 

Thanks for your question.

 

Contrast media can pose serious health risks to patients with chronic or acute renal insufficiency including potentially fatal nephrogenic systemic fibrosis (NSF) or contrast-induced nephropathy (CIN). Creatinine measurement of renal function is recommended prior to administration of contrast media especially for patients with risk factors such as diabetes, kidney impairment, and advanced age.

Many practices perform the lab service in-house. If this is the case, be sure you have an order from the treating physician for the test. You will need to be sure you are performing a CLIA-waived test, as well. This depends on the equipment you use. If your equipment is CLIA waived, remember to add modifier QW (CLIA waived test) on your Medicare claims.

Experts recommend simplifying the logistical and compliance hassles by having the referring physician order the test from a lab when he feels it is necessary.

On the basis of criteria for testing, the appropriate ICD-10CM code will be Z01.812 (Encounter for preprocedural laboratory examination).

 

Thanks

Charlene Posted Wed 27th of February, 2019 08:54:48 AM
I still have a few questions....1) An order is required for POC creatinine prior to CT and you state the order needs to come from the treating physician for the test. Can this order be written with all CT orders as "based on CT criteria"? 2) If a referring physician sends a patient that has had a creatinine test performed earlier, what is the time frame of that test to be valid? 3) As this is a multi-specialty practice who performs diagnostic imaging for the healthcare community as well, can our director of radiology have a standing order in place for POC creatinine based on the CT criteria? or order written for each individual patient based on the criteria? 4) Is a hand-stamped order sufficient.
SuperCoder Answered Thu 28th of February, 2019 09:08:06 AM
Hi,
 
1. It is not necessary for all CT orders. If patient do not have kidney failure, renal (kidney) insufficiency, diabetes, high blood pressure, cancer and currently on chemotherapy, then provider may or may not advise patient to go for creatinine test.
 
2. There is no fixed time frame for the test to be a valid test. The time frame depends upon the payer’s policy. Some payers have 30 days of time frame policy and some payers have less than 30 days of validity. Please check your payer policy for time frame validity.
 
3. There should be a written order for each individual patient from the treating physician for the test.
 
4. For hand-stamped order, its all depend upon payer to payer policy. Some payer allows hand stamped order whereas some payers required hand written note on patients records.
 
Thanks
Charlene Posted Thu 28th of February, 2019 09:25:19 AM
It patient had creatinine test 10 days prior to CT imaging, would that test be a valid test to waive the POC creatinine testing?
Charlene Posted Thu 28th of February, 2019 14:22:42 PM
Can you reference the CMS guidelines regarding the pre-procedural orders written orders and those for the creatinine testing/CT imaging.
SuperCoder Answered Fri 01st of March, 2019 05:20:12 AM

Hi,

Payers have different policies for time frame of test validity. So, please check your payer policy time validity as per your payer and as per your locality.. 

 

Please check the below link:

https://www.supercoder.com/coding-newsletters/my-radiology-coding-alert/reader-questions-confirm-where-82565-was-performed-article

 

Thanks

 

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