No Longer Billing Fingerstick Glucose Testing

Literally asking for a friend here. LOL. But my supervisor overheard another lab professional state that they no longer charge / bill for fingerstick glucose testing at their facility. This being the only part he/she overheard I was baffled as lab billables are already hard to come by. My thought was that the ability to charge for this test was either wrapped into something else or moved to the nursing units. I am at a loss. If anyone else has experienced this at their facility or know what may be the case, please offer a perspective. I don't know any lab that can afford to lose those billiables and I want to be assured that my facility would not be asked to do so in the future. Thanks in advance.

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We were told by our billing department that we could no longer bill for finger stick glucoses because there was not a physician order for each test.  We fought it and lost.  We do about 800-1000 poc glucoses a day and it was quite a hit on our revenue chain.


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The HCP here have the option to order testing as PRN (though this seems to apply more towards blood gases). For our diabetics, the HCP have the option of "Bedside glucose collection q4h" or the such.  Would this be an option?

Wow Jean! But I am curious if what Debra said would work for you. Is that what you meant by fought and lost?

If you are a diabetic, you have to regularly test your blood glucose in order to stay alive. Being a patient in the hospital puts you at an even higher risk of a hyper or hypoglycemic event, therefore the ONLY reason we have glucose meters in the hospitals is to monitor diabetes control.

It would be completely unfair to bill a patient for that service. We do not allow them to use their own meters as a patient, therefore the only option to keep them alive is to run the glucoses for them.  That is a part of their room charge for their stay, and you definitely should not be billing for every single individual glucose test. You can certainly attach a CPT to the test code, but I would be highly shocked if your revenue department is not backing out that charge on the back end.  There are tons of rules around how many labs can be billed for an inpatient - you can only bill for one Basic or Comp Metabolic Panel in a 24 hour period for example - doesn't matter if the doctor orders 10, you may only bill for one.

 

So, no I don't find that surprising. There are a ton of things that we give to patients to keep them alive in the hospital, and at the end of the day they are billed for their stay or the procedure they came in for, not every little thing we do such as individual glucose tests.

Thanks Silka! I agree. I am not really worried about the charge but more so the fact that it is counted as a billable.

Historically what I see is a no charge CPT attached to the test. That way it counts as a billable, but the charge is $0.00

This has been a debate since the start of POCT. I presented this at AACC in the early 2000's when it was a big hot button item.

POCT Glucose tests are a lab test and as such are chargable with an order. They are sometimes they are included in the procedure charge (Cardiac Rehab) but that is not the norm.

I have worked in hosptial sytems that have had differeing viewpoints. 

If the doc orders it...AND coding can prove the orders...they can be charged and maybe some of them will be paid. You are then getting into DRG, insurance companies etc....depending on how many you do, you might get paid enough after discounts from insurance companies to pay for your reagents per year. Only one system in San Antonio currently charges for glucose. Some of the larger individual hospitals do charge here also.

In one system I worked in, they were not charged as the system thought it was too much trouble for the patient payer mix that they hosted.

 

 

 

 

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c07.pdf

pg 18 describes why you can't bill Medicare - since it only gets more complicated from that point, most hospitals determine that it is not worth the resources to determine if each and every single glucose test has an order and the patient is not Medicare and other factors. Much simpler to build into the room charge along with bandaids and gauze and such.

Thanks Deanna. You answered quite of bit of my questions and concerns.

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