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Investigations 101- Laboratory Services Fraud and Abuse

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Order (and Requisition) The order is a communication from the treating practitioner requesting that a certain test be performed. This can be communicated in writing, via a phone call or email and is recorded in the patient's medical record. The Centers for Medicare & Medicaid Services (CMS) requires that the practitioner clearly document in the medical record his or her intent that the test be performed. 3 The requisition form is the actual paperwork provided to the laboratory specifying the testing to be performed. In many cases, practitioners sign the requisition to indicate their intent for the testing and to simplify recordkeeping. Tip: When requesting records for laboratory service claims, be sure to ask for the order and the requisition. If there are questions about the validity of the requisition, it may be necessary to review claims from the ordering practitioner to confirm their treatment and associated diagnoses for the member. In some cases it may be necessary to request the ordering practitioner's progress note to confirm their intent and the medical necessity for the testing. 2 Collection and Handling A specimen must be collected to undergo testing. Sterile procedures must be followed and the collection should be noted in the patient chart. Depending on the type of specimen (tissue, for example), the location on the person's body may be noted as well as the type of collection process used. Specimen handling may be billed separately under Current Procedural Terminology (CPT) 99000, which is defined as "Handling and/or conveyance of specimen for transfer from the physician's office to a laboratory." 4 It is also important to note that for test results to be valid and useful to the ordering practitioner, specimen requirements for volume, storage temperature and any other special handling requirements must be followed.

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