Code Information and Courses from MediaLab, Inc.
These are the MediaLab courses that cover Code and links to relevant pages within the course.
Learn more about laboratory continuing education for medical technologists to earn CE credit for AMT, ASCP, NCA, and state license renewal and recertification. Or get information about laboratory safety and compliance courses that deliver cost-effective OSHA safety training and continuing education to your laboratory's employees.
| Broken Security Seal If a security seal is broken while being removed from the CCF or during the application of the first seal on the primary specimen vial, the collector should transfer the information to a new CCF and use the seals from the second CCF.If one seal is already in place on a specimen vial and second seal is broken while being removed from the CCF or is broken during application on the second specimen vial or while the employee is initialing either seal, the collector should initiate a new CCF and note in the "Remarks" section how the seals were broken. The seals from the second CCF should be placed perpendicular to the original seals to avoid obscuring information on the original seals. The donor must initial the second set of seals also. The initials on all the seals must match. The collector should then draw a line through the specimen ID number (and bar code if present) on the original seals to ensure that the laboratory does not use that number for reporting the results. The collector must not pour the specimen into new vials. | View Page |
| Terrorism Defined The United States Code, Title 22, Chapter 38, Section 2656f(d)(2) defines terrorism as: “Premeditated, politically motivated violence perpetrated against noncombatant targets by sub-national groups or clandestine agents.” Terrorism, then, is the use of force or violence against persons or property in violation of the criminal laws of the United States for purposes of intimidation, coercion, or ransom. Terrorists use threats to create fear among the public in an effort to convince them that their government is powerless to stop acts of terrorism. It is also a way for the terrorists to get publicity for their causes. | View Page |
| Laws and Rules of the Florida Board As a clinical laboratory science worker in the state of Florida, you are bound by several sets of laws designed to protect you, your employer, and patients of the facility in which you work.
This program summarizes the major pieces of legislation that govern Clinical Laboratory Science in Florida and explain how these laws affect you at your job. These are Chapter 483, Part III Florida Statutes and Rules: Chapter 64B3, Florida Administrative Code.
Important: This course is only a brief summary of Florida legislation. While every effort has been taken to include all relevant laws and requirements, we encourage you to review the complete legislation, available at http://www.doh.state.fl.us/mqa/ClinLab/clp_statutes.html. | View Page |
| Your Role As a clinical laboratory worker, your role is vital in the health care process. You provide information to doctors, nurses, and healthcare organizations that is vital to proper patient care.
Because your role is so important, you must be properly qualified, trained, and licensed for your position. You must also keep up with the latest laboratory techniques and developments by fulfilling continuing education requirements. And you are bound by a code of ethics, which ensures that patient results are accurate, reliable, and free from error and bias. | View Page |
| The major pieces of legislation that govern clinical laboratory science in Florida are: | View Page |
| Coding CPT (Current Procedural Terminology) codes are used to describe specific tests or services.
The amount of payment for a test is dependent on the CPT code.
It is against the law to use the wrong CPT code for a test for the purpose of causing or increasing payment for a test.
ICD-9CM (International Classification of Disease, 9th Edition, Clinical Modification) codes are used to classify diseases and conditions, and describe signs, symptoms and medical circumstances.
ICD-9CM codes are used to indicate the medical necessity of a particular test.
It is against the law to use the wrong ICD-9CM code for the purpose of causing or increasing payment for a test.
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| Medical coverage policies (LMRPs) LMRPs (Local Medical Review Policies) are published by Medicare for some laboratory tests.
Developed for tests that can be used for screening or diagnosis of disease.
CPT codes describe laboratory tests and ICD-9CM codes determine when coverage is allowed.
If an LMRP test is ordered by a physician, an ICD-9CM code that is included in the LMRP must be given to the laboratory or the Medicare program will not pay for the test.
It is against the law for laboratory to change or add an ICD-9 code submitted by a physician.
The Balanced Budget Act of 1997 made it illegal for physicians to order LMRP tests and not supply an ICD-9CM code with the order.
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| HCPCS and CPT coding The HCFA (Health Care Financing Administration) Common Procedural Coding System (HCPCS) and the CPT (Current Procedural Terminology) codes are used to describe specific tests or services.
The amount of payment for a test is dependent on the HCPCS or CPT code.
HCPCS or CPT codes should be assigned under the supervision of the laboratory technical staff.
Billing department employees should never change a HCPCS or CPT code without the approval of a manager or compliance officer.
If a billing department clerk notices that a particular HCPCS or CPT code is being rejected by a payer they should report it to their manager.
It is against the law to use the wrong HCPCS or CPT code for the purpose of causing or increasing payment for a test.
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| ICD-9CM coding ICD-9CM (International Classification of Disease, 9th Edition, Clinical Modification) codes are used for the classification of disease and conditions and for describing signs, symptoms and medical circumstances.These codes are used to indicate the medical necessity of a particular test.ICD-9 codes can only be supplied by the ordering physician or a representative of that physician.
"Code steering" means to steer or direct a physician to supply an ICD-9 code that is payable.
ICD-9 codes cannot be used from a previous laboratory order.
If a physician supplies a narrative description instead of an ICD-9 code the laboratory must accurately translate that code using only certified coders.It is against the law to use the wrong ICD-9 code for the purpose of causing or increasing payment for a test. | View Page |
| Local medical review policies (LMRPs) LMRPs (Local Medical Review Policies) are published by Medicare for some laboratory tests.
They are usually developed for tests that can be used for screening or diagnosis of disease.
LMRPs use CPT codes to identify the tests and ICD-9 codes to determine when coverage is allowed.
If an LMRP test is ordered by a physician, an ICD-9 code that is included in the LMRP must be given to the laboratory or the Medicare program will not pay for the test.
It is against the law for laboratory to change or add an ICD-9 code submitted by a physician.
A laboratory should not submit a claim for an LMRP test that is not accompanied by an acceptable ICD-9 code.
The Balanced Budget Act of 1997 made it illegal for physicians to order LMRP tests and not supply an ICD-9CM code with the order.
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| Communication with physicians and patients It is important that billing department employees are clear and accurate when communicating with physician office personnel and patients.
Never guess at the answer to a question; ask if you are unsure.
Do not speculate or express personal opinions.
When requesting diagnosis information from the physician office staff be careful to not lead them to give a billable code:
The code must come from the patient's medical record.
There is an incentive program for patients to find and report fraud and abuse by health care providers, including laboratories, so:
Billing department employees must accurately state laboratory policies and procedures, or forward the call to a supervisor to avoid misstatements and misunderstandings.
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| Advance Beneficiary Notices (ABNs) A Laboratory may not bill a Medicare Beneficiary for a test unless it notifies the patient in writing before the testing is done that Medicare is not going to pay for the test. This notice is called an ABN.
Laboratories cannot make all Medicare beneficiaries sign ABNs.
The ABN must contain the specific name of the test and give a specific reason the laboratory thinks payment for the test will be denied.
The beneficiary should sign the ABN and a copy should be sent to the laboratory and one given to the beneficiary.
The billing department must have evidence that the ABN has been signed before it bills a patient.A laboratory may bill Medicare even though it knows it will not be paid when it has evidence an ABN has been signed.
A modifier (GA) must be added to the CPT code for a test where an ABN has been signed.
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| ICD-9 codes and ABNs Never use sign and symptom information received from a patient for laboratory billing purposes.Never use ICD-9 codes from previous visits for a new visit even if the request is for the same test and the patient assures you that it is for the same reason. (Standing orders are an exception.)ICD-9 codes should be requested when setting up standing orders and will then apply to all subsequent visits. It is not necessary in this case to get a new ICD-9 code for each visit.If the patient refuses to sign an ABN but demands to have the test done:
Have the fact that they were given notice (ABN) witnessed by a second person. (By phone if you are located in single-person drawing site).
Ensure that documentation is complete.
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| Case Study 8 The setting is a billing office in a laboratory where two or more clerks work together in very close proximity with each other, so that each can easily see what the other is doing. A billing clerk notices that one of his fellow employees is changing or adding codes to requisitions he is processing. This employee is a friend of his and he knows that he really needs the job at the laboratory because he is a single parent raising two kids. He also knows that what the employee is doing is against the company's compliance policies.He asks the employee about it and is given the explanation that because the computer requires something to be entered in the ICD-9 code field and he only does this with non-Medicare patients, it doesn't matter. The employee explains that it saves him a lot of time he uses to call to get codes for the Medicare patients. What should this clerk do about this?Correct Answer: She should talk to the supervisor about the problem even if she talks to the employee about it and the employee says she will talk to the supervisor and stop doing it.Discussion: Every employee who becomes aware of a violation of the law or a compliance policy has a responsibility to take action, which includes reporting the problem to a supervisor or the compliance officer. It doesn't matter that these patients are not Medicare patients, the important thing is that the employee is violating a compliance policy. If this employee does not report the problem he is himself violating a compliance policy. If it is subsequently discovered that he knew and didn't report it, he could be terminated. If there is a need for refunds to be done or other action, it will not occur and could create a big problem for the lab in a subsequent audit or other action. | View Page |
| Case Study 1 A billing clerk is entering billing demographics on requisitions as a part of the normal days work. The department is under pressure to reduce accounts receivable, which means that the more clean claims that are filed, the better. This particular requisition is for a Medicare patient and has an LMRP test but does not have a diagnosis on it. She remembers that just a few requisitions before this one she had a requisition from the same doctor that had this same test on it that did have a diagnosis that allowed the test to be billed. She thumbs back in the pile and finds the previous requisition, notes the code that was used and adds it to the current requisition. This will help her meet the department goal of getting claims paid and reducing accounts receivable. It is all right for her to do this because:Correct Answer: She should not do this because it is against the law to change diagnosis information on a requisition.Discussion:
A laboratory employee should never change, add or use previously received diagnosis information for the purpose of making a test billable for the Medicare program or for any other insurance or payer. This is a form of fraud and for each claim submitted as a result of this activity the laboratory is liable for a false claim and would have to pay the government back three up to times the reimbursement for the test and up to $10,000 for each claim submitted. Further, if the employee is caught doing this, even if the employee is ignorant of the law and any laboratory policy prohibiting it, she must be disciplined and so should the supervisor. Any employee who notices another employee doing this should correct the employee and report the incident to the department supervisor immediately. | View Page |
| Occupational Exposure Standard In December of 1991, OSHA issued a standard to guard against occupational exposure to bloodborne pathogens.This standard, part 1910.1030 of the Code of Federal Regulations was published in the Federal Register.On November 27, 2001, OSHA published a compliance directive 2-2.69 that now includes the revisions to the original standard.These regulations are law! | View Page |
| Space heaters Electrical space heaters are prohibited unless they are approved for use and inspected by your facilities management department. Space heaters are not permitted in hospital sleeping areas or in laboratories containing flammable liquids or gases. The heating elements in the space heater cannot exceed 212 degrees Fahrenheit, and cannot be exposed elements. Heaters with hot elements, even with guards, are not allowed. The approved heater must be connected directly to an outlet without the use of an extension cord. Reference: NFPA 101 Life Safety Code. National Fire Protection Agency. Paragraph 18/19.7.8. Quincy, MA: 2006. | View Page |
| Professionalism: appearance Your personal appearance will also affect the impression you make.
Comply with your facility’s dress code and personal appearance policies.
Avoid strong perfume, excessively long fingernails, and open toed shoes.
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