CERT and Laboratory Services Medicare Part A

Noridian hosted a CERT and Laboratory Services Ask the Contractor Teleconference (ACT) on May 17, 2011. The following are some issues identified during the CERT audit. • Incorrect coding a urinalysis with microscopy based on protocol. There must be a physician order for the test, Medicare does not accept protocols. • Complete drug screening tests performed without the specific type of drug mentioned. For example is the drug screen specifically for opiates or barbiturates. • Inappropriate use of the 59 modifier to bypass the NCCI edits. An example is the use of 59 modifier applied to CPT 82948 to bypass the NCCI edits. CPT 82948 is a mutually exclusive service to the CPT 82962 and cannot be billed together on one claim. • Monitoring Coumadin levels without a physician order. An order from the pharmacist is not acceptable. • Physician order is received however the intent was not determined. Progress notes must be signed by the physician. The note must clearly support the need for the laboratory services. An example would be a diagnosis of shortness of breath with no documentation to support symptoms as defined by the LCD; will not support the necessity of a BNP.

Source: https://www.noridianmedicare.com