The field of laboratory medical billing is unlike physicians, hospitals, or DME billing specialties. It is centered on a very specific set of CPT codes. The codes used by a lab includes services that are used to evaluate specimens obtained from a patient sample. It won’t be wrong to say that labs run labs. And, that’s what they bill for.

Laboratories carry out testing procedures for samples provided by a doctor who orders them. Once it is done, results are handed over to the doctor, who then uses these results to suggest and finalize treatment procedures for his patients.

Lab samples are required to be prepared and screened by qualified laboratory personnel with the help of a pathologist who assumes the risk of interpretation. This means that a majority of professionals working in a lab and running the tests are lab technicians.

In a normal lab set-up, tests are conducted in a separate facility and the back-office billing responsibilities are handled by a separate department that is generally cut off from the lab. Only at times, a pathologist will need to engage with a patient and perform evaluation and management services. In such cases, the lab will only bill for these services.

Laboratories based on the type of services

Laboratories can be classified into two main types of services, namely clinical and diagnostic. Each of these services includes several other services to conduct tests for a patient’s medical condition.

Clinical Laboratory Services

Clinical laboratory services involve examination of samples obtained from a human body for interpretation of a medical condition and to make a decision for its prevention, diagnosis, and treatment.

The kinds of tests performed can be biological, microbiological, serological, chemical, immuno-hematological, hematological, biophysical, cytological or pathological.

Diagnostic Laboratory Services

Diagnostic lab services are different from simple clinical tests. Clinical tests require a pathologist and a lab technician to run and interpret samples whereas, diagnostic tests require a physician or other certified professional to perform the same.

Some examples of diagnostic laboratory services include specific cytopathology, surgical pathology, hematology, and blood banking services.

Types of laboratories

Just like the type of lab services are different, types of labs themselves, are also different. When working with a primary care physician, there are chances that the staff might be indulged in some amount of lab testing procedures.

If the physician’s office has a certified lab, then you may be billing for a significant number of lab procedures including the E&M services every day. The kind of tests that can be performed in a lab include urinalysis, blood count and some mono-spot tests.

Laboratories performing lab tests are required to be certified in order to bill for the same, or they may not get paid by the insurance payers. Some lab specialties are being discussed below.

Independent Laboratories: The labs that operate independently out of a physician’s office, a hospital, or any external facility are termed as Independent laboratories.



The labs that operate independently out of a physician’s office, a hospital, or any external facility are termed as Independent laboratories. Physician Office Laboratories: The labs that operate with the help of a physician’s office, or within a physician’s office, to perform testing procedures are referred to as physician office labs.



The labs that operate with the help of a physician’s office, or within a physician’s office, to perform testing procedures are referred to as physician office labs. Clinical Laboratories: These laboratory specialties utilize different biological tests to determine a patient’s medical condition by using specimens obtained from them. They are also referred to as CLIA labs.



These laboratory specialties utilize different biological tests to determine a patient’s medical condition by using specimens obtained from them. They are also referred to as CLIA labs. Referring Laboratories: A lab that receives a specimen for testing purposes but further refers to the sample for testing to a different lab is termed as referring labs.



A lab that receives a specimen for testing purposes but further refers to the sample for testing to a different lab is termed as referring labs. Reference Laboratories: The labs that receive the referred sample from a referring laboratory are known as reference labs. They can also be considered as a type of physician office labs as they depend upon an external facility to perform testing.



The labs that receive the referred sample from a referring laboratory are known as reference labs. They can also be considered as a type of physician office labs as they depend upon an external facility to perform testing. Billing Laboratories: The lab that performs testing, E&M procedures, and further bills them to the insurance company for reimbursement are known as billing labs. A majority of these labs have a billing department in-house.



The lab that performs testing, E&M procedures, and further bills them to the insurance company for reimbursement are known as billing labs. A majority of these labs have a billing department in-house. Medicare-Approved Laboratories: These labs meet the criteria laid down by Medicare, and are quite popular among providers. They also have CLIA certification which makes them the first choice for referring labs, hospitals and other physician practices.



Being a laboratory medical billing specialist

Being a lab billing specialist does not ask for any special certification. Just like other billing and coding specialties, certification can be a plus point, but certainly not a requirement. However, knowledge of the lab billing procedures, ICD 10 & CPT codes is mandatory.

That being said, to become a specialized lab biller or coder you have to be detail-oriented, and must carry basic knowledge of medical terminology and human anatomy, not to mention you need to stay updated with the changes in laboratory medical billing guidelines.

Similar to other billing specialties, once you begin lab billing and coding there may be a steep learning curve. But seeking help from a specialist himself can let you overcome the challenges in lab billing.

If you are a lab owner and looking for help with lab medical billing, visit Bikham Healthcare for more information.