Proper Use of Protocols for Dec. 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.

Description	HCPCS/CPT
Complete Blood Count, automated	85027
Complete Blood Count, with differential WBC, automated	85025
Culture, bacterial, quantitative colony count urine	87086

Source: https://www.noridianmedicare.com