Ahhh, Spring is in the air and that means the pollen is too. That familiar “achoo!” echoing might be more than just a fleeting reaction. For many, it’s a persistent reminder of the pollen power that’s currently dominating the atmosphere. Pair that with the fact that flu season is still here for another month, and you might be tired of playing the guessing game with your sniffles and sneezes. Fortunately, respiratory testing can offer valuable insights into what is affecting your airways. But when does the respiratory testing blur into improper billing?
What to look for?
Look for unbundling scenarios such as respiratory lab panels. Respiratory lab panels are a group of laboratory tests designed to identify viruses, bacteria, or other microbes that are causing a respiratory infection. Instead of testing for one or two specific pathogens at a time, a respiratory lab panel can simultaneously detect multiple potential causes of infection. When services that should be billed under a single comprehensive code are instead billed separately, those services are considered unbundled. For example, look for 87804 (flu), 87807 (RSV) and/or 87811 (SARS/COVID) being billed instead of multiplex panel CPT Code(s) 87631 (3-5 targets) and/or 87637 (multiplex amplified probe).
Another frequent issue is billing for medically unnecessary tests. Ordering and subsequently billing for respiratory tests without proper clinical indication is inappropriate. This includes repeat testing without a change in the patient condition or ordering a battery of tests when a more focused approach would suffice. Look for a single probe influenza test billed with complete blood count (CBC), basic metabolic Panel (BMP) and/or chest Xray with. These instances may not warrant blood work and radiological tests.
HCFS has you covered!
Navigating the voluminous types of respiratory tests and respiratory panel tests can be difficult. Breathe easier this pollen season. If you’re using the HCFSPlatform™, we have you covered. Our Artificial Intelligence (AI) models identify spikes and other anomalous billing patterns. Additionally, we have many Alerts set to flag claims related to unbundling panel tests. We also have alerts that STILL look for (and find) improper billing of COVID-19 related tests. Examples of just some of our alerts include:
[2372-20] – UPCODING, RESPIRATORY PATHOGEN PANEL TESTING (RPP)
[2638-01] – SUPPORTING DIAGNOSIS MISSING, INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); RESPIRATORY VIRUS, 12-25 TARGETS
[2778-01] – UNBUNDLING, TARGETED RESPIRATORY LAB PANELS
[2778-02] – UNBUNDLING, TARGETED RESPIRATORY LAB PANELS
If you have questions or comments, you may email us at [email protected].
If you’re not using the HCFSPlatform™, make 2025 your year! If you’re interested in knowing more, email us at [email protected].
HCFS is solely dedicated to providing an efficient, user-friendly solution that incorporates Artificial Intelligence, Pre-pay, Post-pay, Querying, Case Management and Shared Analytics all in ONE integrated platform. Ask about AUDITPLUS – auditing, SVRS, record retrieval and more! Ask about our HCFS Services (record reviews, data mining, you name it!) Click HERE if you want to see a demo!