Compliance Letter to Physicians 
AMA Organ or Disease Panels -- 2011 
Standard Reflex/Confirmation Tests -- 2011 
Standard Profiles -- 2011

Christian Hospital Department of Laboratories is committed to the reliability, trustworthiness, honesty and business integrity expected of a federally funded health-care program participant. Our policy is to provide physicians with the flexibility to choose appropriate tests, ensuring that the convenience of ordering profiles and panels does not distance physicians from making deliberate decisions regarding medically necessary tests.

Annually we notify our physician clients to order only tests that are medically necessary for Medicare or Medicaid beneficiaries. The United States Department of Health and Human Services, Office of Inspector General, reports that a physician who orders medically unnecessary tests may be subject to civil penalties. Any clinical laboratory that follows the Model Compliance Plan for clinical laboratories established by the Office of the Inspector General must provide this type of annual notice to its clients. 

AMA Organ or Disease Panels -- 2011
The panels are broken out to show the individual test components by name and by CPT code. The Centers for Medicare and Medicaid (CMS) -- formerly known as Healthcare Financing Administration (HCFA) -- has changed the way automated chemistry profiles (80002 through 80019) are CPT coded for billing Medicare. For chemistry tests or profiles containing automated chemistry tests ordered after April 1, 1998, CMS has instructed laboratories to examine the profile components and see if they are contained within any of the new organ or disease panels. Laboratories may:

Bill these chemistry tests under the appropriate organ or disease CPT code and bill the other chemistry tests that are not contained within the new organ or disease panel under their own CPT codes
-- or --
Bill each test under its own individual CPT code
Once the Fiscal Intermediary receives the bill, it counts the number of automated multi-channel chemistry tests included in the profile and, for payment purposes, re-bundles the tests into the relevant 80002 through 80019 CPT codes. The Fiscal Intermediary then pays Christian Hospital the established reimbursement amount for that 80002 through 80019 code. The reimbursement amount cannot exceed the CPT code's National Limitation Amount. 

Standard Profiles -- 2011
This list shows certain standard profiles in which every test component is essential to providing a medically valid result. The profile test name, individual test components and CPT codes are part of the list. 

Standard Reflex/Confirmation Tests -- 2011
This list shows the initial test name, CPT code, criteria for performing the confirmation or reflex test(s), name, and CPT code for the confirmation or reflex test(s).

CPT Coding
Christian Hospital Department of Laboratories bills its test procedures to third-party payers, such as Medicare, Medicaid and private insurance. At the same time it bills patients in accordance with any specific CPT coding required by the payer. The CPT codes are provided for the information of our clients. Correct coding often varies from one payer to the next. Do not use these codes without confirming with the appropriate payer that their use is appropriate in each case.

Human Papilloma Virus (HPV) Reflex Testing on Liquid Based PAP Smears
All liquid based Pap tests with a cytologic diagnosis of ASC-US will reflex to HPV in situ hybridization (88365).

In rare cases, you may feel that HPV testing is appropriate regardless of the cytologic diagnosis. You may still request high-risk HPV testing by calling the Department of Laboratories. (Specimens collected in the ThinPrep vial are accepted for HPV testing up to 21 days from the date of collection.) We do not recommend HPV testing on all patients and in some cases, insurance companies may not reimburse for the test without an ASC-US diagnosis.

This HPV testing is available only on liquid-based Pap tests. It cannot be performed on conventional Pap smears collected on glass slides.

For more information, call 314.653.4455.