DEPARTMENT: Laboratory
POLICY DESCRIPTION: Outpatient Laboratory Test Orders
APPROVED: June 1, 2006
EFFECTIVE DATE: June 1, 2006
REFERENCE NUMBER: LAB .009

SCOPE:
 All Hospital Outpatient Clinics, Home Health Agencies, Ordering Physicians and other Qualified Health Professionals.

PURPOSE:
 To ensure outpatient laboratory test orders are written in accordance with CMS guidelines.

POLICY:
 Outpatient laboratory test orders must be documented and medically necessary and must include the essential data elements as defined in this procedure.

DEFINITIONS:
Qualified Health Professional: Individuals qualified by specific state rules and regulations to order outpatient diagnostic tests.

Authorized Personnel: Those persons qualified by specific state rules, regulations, and facility staff by-laws to accept orders for outpatient diagnostic tests.

Medical Necessity: Medicare provides reimbursement only for tests that are medically necessary for the diagnosis or treatment of the patient for whom the tests are ordered.

PROCEDURE:
Outpatient laboratory tests must be processed as follows:

  1. A standardized laboratory requisition form will be used to ensure essential elements are included with each outpatient laboratory order.

  2. Verbal or phone orders may be accepted in accordance with the facility's medical staff by-laws. Written confirmation is required within 24 hours (See Attachment A).

  3. Outpatient tests shall not be performed on UAMS employees or on friends or relative of UAMS Employees without a valid order which includes the essential data elements.

  4. Ordering physicians may utilize other forms such as a personalized prescription pad as long as the essential elements are present.

  5. Outpatient laboratory tests must include the following elements:

    • Name of Physician or Qualified Health Professional ordering tests
    • Address of Physician (if a non-UAMS Physician)
    • Pager Number of Physician or Qualified Health Professional
    • Patient Name (last name, first name, middle initial)
    • Physician or Qualified Health Professional UPIN number (if a non-UAMS Physician)
    • Patient Date of Birth
    • Patient Sex
    • Patient medical record number and billing account number
    • Tests Ordered - Must be individually marked (a line drawn through multiple number of tests is not acceptable).  Only original requisitions are accepted (no copies).
    • Patient demographics including insurance information (if a non-UAMS Patient)
    • Diagnosis, symptom, and/or ICD-9-CM code associated with ordered tests
    • Current Date

  6. Laboratory personnel will be accountable for educating all staff and physician associates responsible for ordering laboratory tests on the use of the standardized form.

  7. Registration and laboratory personnel must review outpatient diagnostic test orders to ensure essential elements exist.

  8. If the registration and/or requisition appear incomplete, the patient will be redirected to the clinic or the registration desk to obtain the required information prior to being drawn.

  9. If diagnosis information is missing, Laboratory personnel are to first call the clinic to obtain the information prior to drawing the patient. Laboratory personnel must document on the requisition with whom they spoke to obtain the information. If Laboratory personnel cannot obtain the information during the phone call or if clinics are consistently noncompliant in providing diagnosis information, the patient will be given the requisition and instructed to return to the clinic to obtain the required information.

  10. Mail-in or drop-in specimens are to be considered the same as outpatient samples. The same criteria as stated above apply with the exception of access to the patient. Samples received without a valid requisition will not be processed. Laboratory personnel will contact the patient's clinic for the required information. Documentation will be maintained as to the time, date and person contacted. Specimens awaiting a requisition or required information will be held until the required information is obtained or until the time the integrity of the specimen is compromised.

  11. Laboratory Central Processing personnel will collect all outpatient requisitions in a central location in the main Laboratory on a daily basis. On a wekkly basis, Processing personnel will pull requisitions for any unbilled laboratory order from information provided on the Unbilled Laboratory Report. Once collected, the requisitions and report will be forwarded to the Medical Services Analyst for review. The Medical Services Analyst will abstract the patient's record if the requisition carries a diagnosis code. If not, the Medical Services Analyst must forward the requisition to Medical Records personnel for coding. Medical Records personnel will code the requisition and return to the Lab for abstracting. The Laboratory will maintain the requisitions by date of service for compliance purposes for a period of no less than 7 years.

REFERENCES:
 Medicare Intermediary Manual 3117.2 (May 1996)
Medicare Conditions of Participation
ACP Regulations, Specimen Collection and Handling (1996) General Edition

 

POLICY AND PROCEDURE APPROVAL FORM

Date: ___                 November 13, 2003_____________________ ____

Department:______Pathology and Laboratory Services______________

Policy
Description:______Outpatient Laboratory Test Orders_______________

Reference
Number: ________ Lab.009______________________________________

APPROVAL

Department
Manager: __________________________________________________

Date Submitted
To Committee: ________June 29, 2006_____________________

Approval Date:________June 29, 2006___________________

Effective Date: ________June 29, 2006______________________

 

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