Common Errors in Billing for Covid-19 Surveillance Testing in Clinical Diagnostic Labs

The Covid-19 pandemic has highlighted the crucial role that clinical Diagnostic Labs play in healthcare. These labs are responsible for conducting various tests to diagnose and monitor the virus, including Surveillance Testing. However, billing for Covid-19 Surveillance Testing can be complex and prone to errors. In this article, we will discuss some of the common errors in billing for Covid-19 Surveillance Testing in clinical Diagnostic Labs.

Failure to Use the Correct CPT Codes

One of the most common errors in billing for Covid-19 Surveillance Testing is the failure to use the correct Current Procedural Terminology (CPT) codes. CPT codes are used to describe medical procedures and services provided by healthcare professionals. For Covid-19 Surveillance Testing, there are specific CPT codes that should be used to ensure accurate billing.

Examples of Commonly Used CPT Codes for Covid-19 Surveillance Testing:

1. 87635 - Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [Covid-19]), amplified probe technique
2. 86408 - Covid-19 simulated saliva screening test (List separately in addition to code for primary procedure)

Incomplete or Inaccurate Documentation

Another common error in billing for Covid-19 Surveillance Testing is incomplete or inaccurate documentation. Proper documentation is essential for accurate billing and Reimbursement. Clinical Diagnostic Labs should ensure that all necessary information, such as the patient's demographic information, Test Results, and ordering provider, is included in the billing documentation.

Key Elements of Documentation for Covid-19 Surveillance Testing:

1. Patient's demographic information (name, date of birth, etc.)
2. Date of service
3. Ordering provider's information
4. Specific test performed
5. Test Results

Upcoding or Unbundling

Upcoding and unbundling are billing practices that involve improperly increasing the level of service provided or breaking down services that should be billed together into separate billable components. These practices can result in overbilling and potential compliance issues for clinical Diagnostic Labs.

Examples of Upcoding and Unbundling for Covid-19 Surveillance Testing:

1. Using a higher-level CPT code for Covid-19 Surveillance Testing than what is appropriate for the services provided
2. Separately billing for components of a Covid-19 surveillance test that should be bundled together

Failure to Verify Insurance Coverage

Another common error in billing for Covid-19 Surveillance Testing is the failure to verify Insurance Coverage. It is essential for clinical Diagnostic Labs to verify the patient's Insurance Coverage and obtain any necessary prior authorizations before conducting Covid-19 Surveillance Testing. Failure to do so can result in delayed or denied claims.

Steps to Verify Insurance Coverage for Covid-19 Surveillance Testing:

1. Collect the patient's insurance information
2. Contact the patient's insurance company to verify coverage for Covid-19 Surveillance Testing
3. Obtain any necessary prior authorizations

Improper Use of Modifiers

Modifiers are two-digit codes that are used to provide additional information about a service or procedure provided by healthcare professionals. In the context of billing for Covid-19 Surveillance Testing, improper use of modifiers can lead to claim denials or payment delays.

Examples of Commonly Used Modifiers for Covid-19 Surveillance Testing:

1. Modifier -QW - CMS.gov/medicare/quality/clinical-laboratory-improvement-amendments" target="_blank">CLIA-waived test
2. Modifier -GT - Via interactive audio and video telecommunications systems

Conclusion

In conclusion, billing for Covid-19 Surveillance Testing in clinical Diagnostic Labs requires attention to detail and compliance with coding and documentation guidelines. By avoiding common errors such as using incorrect CPT codes, incomplete documentation, upcoding or unbundling, failing to verify Insurance Coverage, and improper use of modifiers, clinical Diagnostic Labs can ensure accurate billing and Reimbursement for their services.

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