Laboratory Services Laboratory Procedures Anthem is contracted with Laboratory Corporation of America (LabCorp ). All lab work, including Pap tests and routine outpatient pathology, must be sent to LabCorp, with the exception of the procedures listed below: Note: This relationship with LabCorp is specific to national reference lab services and does not affect network hospital-based lab service providers or contracted pathologists, or independent laboratories. Lab Work Provided in the Provider s Office 80048 Metabolic panel total 86308 Heterophile antibodies (momo spot) 81000 Urinalysis, nonauto w/scope 86403 Particle agglutination test (Rapid Strep) 81001 Urinalysis, auto w/scope 86403 Particle agglutination test (Rapid Strep) 81002 Urinalysis nonauto w/o scope 86580 TB intradermal test 81003 Urinalysis, auto, w/o scope 8358587081 Skin Test: tuberculosis, tine testculture screen only (Rapid Strep) 81005 Urinalysis 8707087205 Culture, bacteria, other Smear, gram stain 81007 Urine screen for bacteria 8708187210 Culture screen only (Rapid Strep) Smear, wet mount, saline/ink 81015 Microscopic exam of urine 8720587220 Smear, gram stain Tissue exam for fungi 81025 Urine pregnancy test 8721087430 Smear, wet mount, saline/ink Strep a ag, eia (Rapid Strep) 82120 Amines, vaginal fluid, qualitative 8722087802 Tissue exam for fungiinfectious agent antigen detection by immunoassay with direct optical observation; Stretococcus, group B 82270 Occult blood, feces 8743087804 Strep a ag, eia (Rapid Strep) Influenza assay w/optic 82271 Occult blood, other sources 8780287807 Infectious agent antigen detection by immunoassay with direct optical observation; Stretococcus, group BRsv assay w/optic 8246582803 Assay, bld/serum cholesterolgases, blood, any combination of ph, pc02, p02, C02, HC03 (including calculated 02 saturation). This procedure approved for Pulmonologists ONLY. 8780487880 InfluenzStrep a assay w/optic 8280382947 Gases, blood, any combination of ph, pc02, p02, C02, HC03 (including calculated 02 saturation). This procedure approved for Pulmonologists ONLY. Glucose; quantitative (except reagent strip) 8294782948 Glucose; quantitative (except blood reagent strip) 8294882962 Glucose; blood reagent strip by glucose monitoring device(s) cleared by the FDA specifically for home use. 8296285002 Glucose; blood by glucose monitoring device(s) cleared by the FDA specifically for home use. Bleeding time 8780789260 Rsv assay w/optic Sperm isolation; simple prep (e.g., sperm wash and swim-up) for insemination or diagnosis with semen analysis. 8788089261 Strep a assay w/optic Sperm isolation; complex prep (e.g., Percoll gradient, albumin gradient) for insemination or diagnosis with semen analysis 8926089300 Sperm isolation; simple prep (e.g., sperm wash and swim-up) for insemination or diagnosis with semen Semen analysis. w/huhner 8926189310 Sperm isolation; complex prep (e.g., Percoll gradient, albumin gradient) for insemination or diagnosis with semen Semen analysis w/count ALL: OCTOBER 2009 10.1
Lab Work Provided in the Provider s Office 8500285007 Bleeding time Blood count; blood smear, 8930089320 Semen analysis w/huhner, complete microscopic examination with manual differential WBC count 8500785013 Blood count; blood smear, microscopic 8931089321 Semen analysis w/count& motility examination with manual differential WBC count Spun microhematocrit 8501385014 Spun microhematocrit Hematocrit 8932089330 Semen analysis, complete Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test 8501485018 Hematocrit Hemoglobin 89321G0027 Semen analysis & motility 8501885025 Hemoglobin Complete CBC w/auto diff WBC 89330 Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit test 85610 Prothrombin time G0027 Semen analysis 86308 Heterophile antibodies (momo spot) Lab procedure codes for procedures that can be performed at the physician s office can be billed as fee-for-service. Anthem will pay for the lab procedure only. The drawing fee is incorporated into the lab procedure; therefore, the physician will not be reimbursed for an additional drawing fee. Anthem will pay a drawing fee to a physician who sends ALL lab work to LabCorp. (Please bill with procedure code 36415 routine venipuncture.) Codes on this list are not a guarantee of payment. Coverage may be restricted by member benefits. If the physician performs blood tests in his/her office and also sends additional blood to LabCorp for testing, the physician will NOT be reimbursed for the drawing fee. The handling fee, code 99000, is not allowed in addition to the 36415 venipuncture code or the E&M code. Codes 99000 and 36416, collection of capillary blood specimen (eg. Finger, heel, or ear stick) are on the Always Bundle/Bundled Services and Supplies policy and are considered part of the overall medical management of the patient and are not allowed separately. Reviewing results of laboratory tests, phoning results to patients, filing such results, etc., are included in Anthem s allowance for the E&M code, even if the E&M code is not on the same day. A charge related to drawing of blood performed by an OB/GYN is payable as a separate service and isn t included in the total obstetrical allowance if the blood is sent to the lab. An appropriate diagnosis to justify the procedure must accompany all lab procedures. Specimen collections: For specimen requirements for various lab tests, collection procedures, specimen preparations and submission protocols, please call LabCorp toll free at 800-795-3699. Instructions for certain labile specimens are as follows: Routine pediatric specimen collections can be performed at the drawing stations of the independent laboratories contracted with Anthem. Stat: If an emergency situation exists and you can t wait for LabCorp s stat turnaround (three to four hours from the time the lab is called), you can mark STAT on your claim form for that lab procedure. However, Anthem will pay the lab charge only and will not pay for STAT fee charges. If the original claim doesn t denote STAT and is denied for payment because it should have been sent to LabCorp, Anthem will not pay at a later date even if the claim is resubmitted with STAT marked on it. Cerebrospinal fluid/bone marrow aspirate: Due to the labile nature of these specimens, Anthem recommends that they be transported to the nearest hospital for analysis. Please call LabCorp for information or instructions. This also helps with reporting results properly and obtaining written copies of the results. Non-gynecologic cytology: Place specimens such as urine, bladder washing, body fluids (peritoneal, gastric), cyst fluids and cerebrospinal fluids in a clean, leak-proof container with an equal volume of 50 percent alcohol. Histology: Place tissue in leak-proof biopsy bottles containing 10 percent formalin in a volume five times that of the specimen. Do not use a preservative if microbiological cultures are required. LabCorp will contact Providers if it receives inadequate, inappropriate, or improperly prepared or stored specimens. ALL: OCTOBER 2009 10.2
Lab Services Covered as Part of Preventive Care Benefits When a member s health plan includes preventive care benefits, the following lab tests are covered when billed with a preventive diagnosis code. Any code not listed below requires a medical diagnosis when billing Anthem. These lab tests should be sent to a contracted laboratory provider. Lab Services Covered as Part of Preventive Care Benefits 80048 Basic metabolic panel (Calcium, total) 83721 Assay of blood lipoprotein 80050 General health panel 84030 Phenylaline (PKU) 80051 Electrolyte panel 84075 Assay alkaline phosphatase 80053 Comprehensive metabolic panel 84132 Assay of serum potassium 80061 Lipid panel 84152 Assay of psa, complexed 80076 Hepatic Function Panel 84153 Assay of psa, total 81000 Urinalysis, nonauto w/scope 84154 Assay of psa, free 81001 Urinalysis, auto w/scope 84155 Assay of protein, serum 81002 Urinalysis nonauto w/o scope 84295 Assay of serum sodium 81003 Urinalysis, auto, w/o scope 84443 Assay thyroid stim hormone 81005 Urinalysis 84450 Transferase (AST) (SGOT) 82040 Assay of serum albumin 84460 Alanine amino (ALT) (SGPT) 82247 Bilirubin, total 84478 Assay of triglycerides 82270 Blood, occult feces 84520 Assay of urea nitrogen 82274 Blood, occult feces 85004 Automated diff wbc count 82310 Assay of calcium 85007 Bl smear w/diff wbc count 82374 Assay, blood carbon dioxide 85009 Manual diff wbc count b-coat 82435 Assay of blood chloride 85013 Spun hematocrit 82465 Assay, bld/serum cholest 85014 Hematocrit 82565 Assay of creatinine 85018 Hemoglobin 82776 Galactose transferase test 85025 Complete cbc w/auto diff wbc 82947 Assay, glucose, blood quant 85027 Complete cbc, automated 82951 Glucose tolerance test (GTT) 86255 Fluorescent antibody, screen 82952 GTT-added samples 86256 Fluorescent antibody, titer 83020 Hemoglobin electrophoresis 86316 Immunoassay, tumor other 83700 Lipopro bld, electrophoretic 86355 Immunfix e-phorsis/urine/csf 83718 Assay of lipoprotein 86480 Tb test, cell immun measure 83719 Assay of blood lipoprotein 86580 TB intradermal test 86592 Syphilis test, qualitative 88150 Cytopath, c/v, manual 86593 Syphilis test, quantitative 88152 Cytopath, c/v, auto redo 86631 Chlamydia antibody 88153 Cytopath, c/v, redo 86632 Chlamydia igm antibody 88154 Cytopath, c/v, select 86689 HTLV/HIV confirmatory test 88155 Cytopath, c/v, index add-on 86701 HIV-1 88160 Cytopath smear, other source 86702 HIV-2 88161 Cytopath smear, other source 86703 HIV-1/HIV-2, single assay 88162 Cytopath smear, other source ALL: OCTOBER 2009 10.3
Lab Services Covered as Part of Preventive Care Benefits 86762 Rubella antibody 88164 Cytopath tbs, c/v, manual 87110 Chlamydia culture 88165 Cytopath tbs, c/v, redo 87272 Cryptosporidium ag, if 88166 Cytopath tbs, c/v, auto redo 87320 Chylmd trach ag, eia 88167 Cytopath tbs, c/v, select 87390 Hiv-1 ag, eia 88172 Cytopathology eval of fna 87391 Hiv-2 ag, eia 88173 Cytopath eval, fna, report 87485 Chylmd pneum, dna, dir probe 88174 Cytopath, c/v auto, in fluid 87486 Chylmd pneum, dna, amp prob 88175 Cytopath c/v auto fluid redo 87490 Chylmd trach, dna, dir probe 88271 Cytogenetics, dna probe 87491 Chylmd trach, dna, amp probe 88291 Cyto/molecular report 87590 N.gonorrhoeae, dna, dir prob G0103 Psa, total screening 87591 N.gonorrhoeae, dna, amp prob G0123 Screen cerv/vag thin layer 87592 N.gonorrhoeae, dna, quant G0124 Screen c/v thin layer by MD 87620 Hpv, dna, dir probe G0141 Scr c/v cyto, autosys and md 87621 Hpv, dna, amp probe G0143 Scr c/v cyto,thinlayer,rescr 87622 Hpv, dna, quant G0144 Scr c/v cyto,thinlayer,rescr 87850 N. gonorrhoeae assay w/optic G0145 Scr c/v cyto,thinlayer,rescr 88141 Cytopath, c/v, interpret G0147 Scr c/v cyto, automated sys 88142 Cytopath, c/v, thin layer G0148 Scr c/v cyto, autosys, rescr 88143 Cytopath c/v thin layer redo P3000 Screen pap by tech w md supv 88147 Cytopath, c/v, automated P3001 Screening pap smear by phys 88148 Cytopath, c/v, auto rescreen Other Considerations A physician or other health care Provider may not bill for services sent to an outside lab. This includes cytopathology services for cervical cancer screening (Pap codes 88141-88175 and P3000-P3001). Codes 88141-88175 and P3000-P3001 are to be used by the laboratory performing the test, not by the physician obtaining the specimen. Effective with ClaimsXten implementation on or after 11/07/2009, Pap smear codes will be denied when reported with E&M codes. Q0091-Obtaining the specimen for cervical cancer screening is included in the allowance for and is thus incidental to the evaluation and management (E&M) or the preventive care visit service. For members without preventive care benefits billing Q0091 alerts us that a Pap smear was done and the visit code can be allowed. For additional tips on billing pap smears for individual members see the coding tips and lab sections of this document. Specialized Anatomic Pathology LabCorp is a leader in innovative diagnostic testing, with active research and development groups. Some of its specialized services include the following: A.P. triple screens AIDS-related testing, including genotype and phenotype analysis Allergy (RAST and Imunocap) testing Genetic/cytogenetic testing with board-certified cytogeneticists and genetic counselors available for consultation Tumor marker testing DNA probe testing ALL: OCTOBER 2009 10.4
For information about specialized assays or about requirements for special collection kits and specimen handling, call LabCorp at 888-LABCORP (888-522-2677) LabCorp Patient Service Centers To find a LabCorp location near you, go to www.labcorp.com or call the phone number above. ALL: OCTOBER 2009 10.5