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CRIP, section 3-1
Certified Revenue Integrity Professional - Ancillary Services
| Question | Answer |
|---|---|
| What are the types of Laboratories? | Independent Laboratory Physician Office Laboratory Clinical Laboratory Qualified Hospital Laboratory Referring Laboratory Reference Laboratory Draw Station |
| Define Independent Laboratory | A lab that is independent of a hospital that meets the requirements to qualify as an emergency hospital or is independent of an attending or consulting physician. |
| Define Physician Office Laboratory | A lab area in a physician's office that is maintained by the physician or group practice and is utilized to perform diagnostic tests. |
| Define Clinical Laboratory | A lab that offers to review microbiology, chemistry, serology, immunoassay, cytology, pathology svcs, etc. Must be certified to meet requirements of the CLIA (Clinical Lab Improvement Act) unless the lab is exempt. |
| What is the CLIA and what does it do? | Clinical Laboratory Improvement Act Regulations establish quality standards to for lab testing performed on specimens from humans, such as blood, body fluid and tissue for the purpose of diagnosis, prevention of disease or assessment of health. |
| Define Qualified Hospital Laboratory | A lab that provides clinical lab tests 24/7 to serve a 24/7 hosp ER. To meet this requirement, hospital must have physicians present or available w/i 30 min through a medical staff call roster. Also needs hospital lab techs on duty or on call the same. |
| Define Referring Laboratory | A lab that receives a specimen to be tested and then refers the specimen to another lab for performance of the actual test. A referring lab must be MC approved. |
| Define Reference Laboratory | A lab that receives a specimen from a referring lab for testing and actually performs the test. |
| Define Draw Station | A facility that collects specimens and sends them to a central lab but does not perform tests of any kind. |
| Explain the DOS lab policy | Per CMS, the DOS policy for clinical lab test or the technical component of physician pathology svcs: - DOS of test must be date of specimen collection. - If collection spans > 1 day, DOS should be the day it ended. |
| Billing for laboratory services for stored specimens: | Stored 30 days or less: As long as the physician ordered the test at least 14 days after discharge, DOS is test date. Stored more than 30 days: the specimen is considered archived, DOS is the date it was obtained from storage. |
| Describe Reflex Lab Testing | Performed subsequent to initial lab test results ordered for the pt. Used to further ID any significant diagnostic info that is deemed appropriate for pt's care. |
| What are the 2 types of Reflex Lab Testing? | Required reflex tests: If possitive, require addt'l f/u testing to have clinical value. Optional Reflex Testing: When initial test has a clinical value w/o the additional reflex testing. |
| What are some of the types of Lab Panels? | Metabolic Panel Comprehensive Lab Panel Renal Function Panel Lipid Panel Electrolyte Panel Hepatic Function Panel |
| How are Lab Panels billed? | Each component can be billed separately, but reimbursement will be based off of the panel itself. |
| Mammography: | Can be for screening or diagnostic Screening: - not covered under age 35 - CMS will pay for 1 mammogram between ages 35th and 39th bday. Over 39: covered annually. 11 full mos after the month of last screening. |
| Billing considerations for mammograms: | If screening and diagnostic mammograms done on same day, use GG modifier. Bill screening as usual with mod 59 and then diagnostic would get the GG modifier to show that diagnostic was done after screening on same day. |
| What does CAD stand for? | Computer Aided Detection - uses a laser beam to scan x-ray film and converts it into digital data for the computer. |
| What is fluoroscopy? | A type of imaging procedure that uses several pulses of an x-ray beam to take real-time footage of tissues inside the body. Acts as imaging guidance for certain procedures. |
| Billing rules for fluoroscopy: | - Unless specifically noted, fluoroscopy that is necessary to complete a procedure is included in the major procedure performed. - Shld only be reported when it isn't included as an integral part of the primary procedure. |
| What is Nuclear Medicine? | A medical specialty involving the application of radioactive substances in the diagnosis and treatment of disease. |
| Billing rules for Nuclear Medicine: | - when billing for a proc requiring the use of radiolabeled product, the bill should contain the HCPCS code for the product on the same claim as the procedure. Pay attn to the the drug descriptions, some require a unit of 1, some require # of actual mg. |
| What does MRI stand for and give detail regarding MRI for pt w/ implanted pacemakers not approved by FDA for MRI: | Magnetic Resonance Imaging - when pt has an implanted pacemaker not approved for MRI by FDA for use in MRI, must include: - proper MRI proc code - Q0 modifier - appropriate dx code: Z00.6, Z95.810 or Z95.0 Condition code of 30 (institutional only) |
| Give detail regarding MRI for pt w/ implanted pacemaker approved by FDA for MRI Environment: | If a pt has an implantable pacemaker that has FDA-approved labeling for use in an MRI environment, submit claim: - w/ appropriate MRI proc code - w/ appropriate dx code: Z95.0 (presence of cardiac pacemaker) - w/ KX modifier |
| Was does PET Scan stand for and give detail: | Positron Emission Tomography (PET) Scans per CMS "PET is a non-invasive imaging proc that assesses perfusion & the level of metabolic activity in various argan systems of the body." They use a radiopharmaceutical given by IV. |
| What is Restaging? | Testing after a course of treatment. Covered for: - detect residual disease - detect suspected recurrence or metastasis - determine extent of a known recurrence - if it replaces 1 or more conventional imaging studies that would not be as effective. |
| Does does MNT stand for and describe: | Medical Nutritional Therapy Covered if provided by a registered dietitian or nutritional professional who meets certain requirements. Available for those diagnosed w/ diabetes or renal disease as long as referred by a physician. |
| How does CMS define diabetes? | Diabetes mellitus, condition of abnormal glucose metabolism. Diagnosed by: - a fasting blood sugar greater than or equal to 126 mg/dL on 2 different occasions or - a random glucose test over 200 mg/dL for a person w/ symptoms of uncontrollable diabetes |
| How does CMS definal renal disease? | A chronic renal insufficiency or the medical condition of a beneficiary who has been discharged from the hospital after successful renal transplant w/i the last 36 mos. |
| What are the benefits of MNT? | - an initial visit for assessment - f/u visits for any interventions that have taken place - reassessments needed during the 12-mos period beginning w/ the initial assessment date. |
| What does DSMT stand for and explain: | Diabetes self management training. CMS allows a beneficiary to receive DSMT and MNT in the same period and will cover it but a provider cannot bill both on the same DOS. |
| Describe the MNT coverage guidelines | MC covers 3 hours of 1 on 1 counseling during the 1st year and 2 hours in all subsequent years. Must have a new referral for each instance, can only be made by treating physician and only when diagnosis of diabetes or renal disease is present. |
Created by:
Amy17349
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