Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Practice Exam

CPC Practice Exam and Study Guide Package

Practice Exam

What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

CPC Exam Review Video

Laureen shows you her proprietary “Bubbling and Highlighting Technique”

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Practice Exam

2018 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

Practice Exam

Click here for more sample CPC practice exam questions and answers with full rationale

Horizon BCBSNJ Reimbursement Guidelines Changes in Outpatient Laboratory Claims

Outpatient Laboratory Claims: Referring Practitioner Required


In accordance with Centers for Medicare and Medicaid Services (CMS) guidelines, Horizon BCBSNJ requires that claims for clinical laboratory services report the referring practitioner on the claim submission. This applies to participating and non-participating providers.

Effective November 15, 2019 Horizon BCBSNJ will change the way consider and reimburse certain clinical laboratory claims that do not include information about the referring practitioner information. 

Based on the guidelines of this reimbursement policy, Horizon BCBSNJ will deny outpatient claims submitted by participating or nonparticipating clinical laboratories for services provided on and after November 15, 2019 if the referring practitioner information is not included.

To avoid claim outpatient clinical laboratory claim denials, include referring practitioner information as noted below,

  • In 837P transactions please include referring practitioner information in Loop 2310A
  • On CMS  1500 claim forms (per the Medicare Claims Processing Manual Chapter 26 – Completing and Processing Form CMS-1500 Data Set), please include the following referring practitioner information
    •  Field 17.    Enter a “DN” qualifier (to denote Referring Provider), and Enter the referring provider name
    •  Field 17b.   Enter the NPI of the referring provider

To address claims denied for no referring practitioner information, clinical laboratories will have to submit a corrected claim that includes this required information. Until such time as this corrected claim information can be submitted and processed, members cannot be held liable for services related to these claim denials.


Source: https://www.horizonblue.com/providers/news/news-legal-notices/reimbursement-policy-implementation-outpatient-laboratory-claims-referring-practitioner-required


Coding Ahead

Physician orders for laboratory tests

Clinic is stating they placed an order for urinalysis ‘digitally’ so they don’t need to submit documentation for the UA. I’m unable to code it as there is no diagnosis or intent for the procedure indicated. What are the documentation requirements for a physician ordered laboratory test? Shouldn’t there be a document in the medical record that corresponds to the ‘digital’ order?

Medical Billing and Coding Forum

Independent Laboratory Billing Place of service code

Hello! We are an independent lab running lcms(80307) and definitive(G0480-G0483) billing for urine collected at the facility the patient is receiving care from and sent to us. United Healthcare (UHC) just started denying our claims for box 24B and box 32. We have always billed with POS 81 in box 24B but they are now denying saying "The place of service for an independent laboratory must show the place where the sample was taken; based on the information provided on the HCFA 1500 box 24B and box 32 and the medical records submitted, we are unable to verify where the sample was obtained."
This is only happening with UHC. All the other commercial carriers have no issue paying our claims after the review of medical records.
Is anyone familiar with this change? Are they correct? and will other payers be moving to this rule?

Any guidance is very much appreciated.

Medical Billing and Coding Forum

13 Laboratory Code Updates Effective Now

Clinical diagnostic laboratories can look forward to 12 new laboratory codes were effective April 1 and one code effective retroactively January 1. The Centers for Medicare and Medicate Services (CMS) released the changes May 5, 2018. The new codes are contractor priced until addressed at the annual Clinical Laboratory Public Meeting in July. All the U […]
AAPC Knowledge Center

Laboratory Billing For Blue Cross Blue Shield

This is a general question that I hope someone can help me with.

We have a patient in which we drew a blood sample for testing. The specimen is being sent to an out of state lab for testing and results. I assume that we bill the state in which the specimen was being tested in, but I have a colleague stating that we bill the state in which the sample was actually drawn in. I’m new to this part of billing, so any feedback would be appreciated! Thank you!

Medical Billing and Coding Forum

2018 Annual Update for Clinical Laboratory Fee Schedule

The codes that are considered a laboratory test under Clinical Laboratory Improvement Amendments (CLIA) change each year. These codes require a facility to have either a CLIA certificate of registration (type code 9), a CLIA certificate of compliance (type code 1), or a CLIA certificate of accreditation (type code 3). A facility with a CLIA […]
AAPC Knowledge Center

Medical Laboratory Technician Training

Work behind the scenes in the health care industry as a medical laboratory technician to help patients live healthier, longer lives. Also known as clinical laboratory technicians or medical technicians, these trained technicians play a vital role in detecting, diagnosing and treating disease.
Overview of Medical Laboratory Technician Training
These trained technicians use cell counters, microscopes and other tools in their day-to-day work. Under the supervision of medical laboratory technologists, who typically have more training and a more complex job, technicians employ their own knowledge to solve mysteries within the human body.
With the help of high-tech devices and a trained eye, medical laboratory technicians use their skills to perform a number of different tasks. A day in the life of a medical laboratory technician might involve the following tasks:
Examine fluids for parasites or bacteria
Match blood from different donors for transfusions
Analyze the chemical content of fluids
Determine how a patient is responding to treatment by testing for drug levels in the blood
Though the job description is broad and includes complex tasks, medical laboratory technicians often find themselves in charge of a fairly automated process. Advanced machines do much of the workload in the job and technicians are there to use their training to properly complete tests, make sure procedures are conducted safely and interpret results.
Like most health care workers, medical laboratory technicians can choose to specialize in one aspect of the field. Below are examples of specialties available to medical laboratory technicians:
Phlebotomists collect blood samples from patients for transfusion or testing
Histotechnicians cut and stain tissue specimens for microscopic examination by pathologists
For workers with the proper training, healthy salaries are a bonus of the career. The Bureau of Labor Statistics (BLS) reports that medical laboratory technicians earned mean annual wages of $ 37,860 in 2009. Those who worked in general medical and surgical hospitals earned slightly more, at $ 38,820.
Medical Laboratory Technician Training: Degrees and Coursework
An associate’s degree or certificate is recommended for medical laboratory technician training. Technicians need to work somewhat independently in the lab, so a high level of responsibility requires a higher level of education.
Medical laboratory technician training typically consists of core medical classes, general education essentials and hands-on laboratory practice. Take a look at some basic courses you might find in a training program for medical technicians:
Microbiology
Organic chemistry
Computer literacy
Laboratory residency
Coursework in a medical laboratory technician training program is designed to give you the fundamentals of clinical training plus the targeted instruction you need to accurately complete and interpret tests.
In addition to completing coursework, securing professional certification helps prove your competence and dedication to the career. The following associations offer certification for medical laboratory technicians:
Board of Registry of the American Society for Clinical Pathology
American Medical Technologists
National Credentialing Agency for Clinical Laboratory Sciences
Board of Registry of the American Association of Bioanalysts
While no career training program or certification can guarantee a career in the field, hiring managers often prefer to take on technicians with formal training experience. Working your way through a formal training program helps increase your knowledge and improve your odds of employment in hospitals, laboratories and doctor’s offices.
Medical Laboratory Technician Career Outlook
The BLS projects excellent job opportunities for medical laboratory technicians in the coming years. An estimated 25,000 new careers for medical and clinical laboratory technicians are expected to enter the industry between 2008 and 2018, for a growth rate of 16 percent.
For career growth within the industry, technicians may return to school to complete a bachelor’s degree in medical technology. From there, education and experience can lead you to a job as a medical technologist or a supervisor in the lab.
The projected career growth is due to the development of new types of tests as well as nationwide population growth. For the best opportunities in the field, aspiring technicians should seek out formal training from an accredited college or vocational school.

thesis methodology

CPT Coding for Laboratory Panels

A laboratory panel is a package of tests that often are ordered together. Each panel code (80047-80076) includes multiple tests. When all the tests included in the panel are ordered, report the panel code. If any test defined as part of the panel is not performed, report the code(s) to describe the individual tests performed. […]
AAPC Knowledge Center

Reference Laboratory Testing

Medicare states that when performing laboratory test by both the billing laboratory and a reference laboratory, you are not to split the claim. You distinguish the test by using modifier 90 for the tests that were referenced out. My question is who’s information goes in box 31 and 32 on the 1500 form? The billing laboratory or the the reference laboratory?

Medical Billing and Coding Forum