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Proper Use of Protocols



Wednesday, December 02, 2009


Noridian Administrative Services, LLC- Carrier/FI for Arizona, Alaska, Idaho, Oregon, Montana, North Dakota, South Dakota, Utah, Washington, Wyoming and Minnesota.

Noridian Administrative Services, LLC (NAS) has noticed an increase of incorrect coding for Complete Blood Count (CBC) and Urinalysis (UA) laboratory services. Recent Comprehensive Error Rate Testing (CERT) analysis indicates providers are performing additional laboratory services based on a standard written or implied protocol, rather than a patient-specific physician order. Protocol is a routine plan to carry out a study or treatment regimen.

Improper Protocol Examples:
  1. White cells or bacteria discovered during a urine test will prompt the laboratory to perform a urine culture based on protocol without a specific order from the physician to perform the culture.
  2. When the laboratory receives an order for CBC the laboratory automatically performs a CBC with differential, although the differential was not specified in the physician order.
DescriptionHCPCS/CPT
Complete Blood Count, automated85027
Complete Blood Count, with differential WBC, automated85025
Culture, bacterial, quantitative colony count urine87086


Medicare, Noridian

Additional Information: Source


Wednesday, December 02, 2009