Independent Lab Billing Process - Genetic Testing (Part -2)

Genetic testing is a type of medical test that identifies changes in genes, chromosomes, or proteins. The results of a genetic test can confirm or rule out a suspected genetic condition or help determine a person’s chance of developing or passing on a genetic disorder. More than 77,000 genetic tests are currently in use, and others are being developed.

Genetic testing involves looking for changes in: 

Genes: Gene tests study DNA sequences to identify variations (mutations) in genes that can cause or increase the risk of a genetic disorder.

Chromosomes: Chromosomal genetic tests analyze whole chromosomes or long lengths of DNA to see if there are large genetic changes, such as an extra copy of a chromosome, that cause a genetic condition.

Proteins: Biochemical genetic tests study the amount or activity level of proteins or enzymes; abnormalities in either can indicate changes to the DNA that result in a genetic disorder.

Next we will come across some terminologies, let's discuss that

Toxicology

Toxicology is a scientific discipline that overlaps with biology, chemistry, pharmacology, and medicine. It involves the study of the adverse effects of chemical substances on living organisms and the practice of diagnosing and treating exposures to toxins and toxicants. 

Generally speaking toxicology refers to the testing of patient samples (like urine, oral fluid, or blood) for the presence of prescribed medications and non-medical use of other drugs. This helps in understanding whether the patient is adhering to the prescribed therapy and not taking any additional substances that could interfere with their treatment or cause harm. 

The field of toxicology helps to predict what, and how chemicals may cause harm and then shares that information to protect public health. Factors that influence chemical toxicity include the dosage, duration of exposure (whether it is acute or chronic), route of exposure, species, age, sex, and environment

Requisition

In medical terms, a requisition is an order for a specific laboratory service or test. It's essentially a formal request made by a healthcare provider (like a doctor or nurse) for a laboratory to perform certain tests on a patient's specimen (like blood, urine, or tissue). The requisition includes important information such as the patient's details, the tests to be performed, and any special instructions. This helps the laboratory know exactly what tests to perform and ensures that the results are sent back to the correct healthcare provider.

Test Menu

In the context of a laboratory, a test menu refers to the list of all the tests that the laboratory is capable of performing. This includes tests that are performed directly by the laboratory and may exclude those tests that are sent to reference laboratories. 

The test menu serves as a catalog for healthcare providers to know what tests are available for them to order. It can include a wide range of tests, from routine blood work to more specialized tests. Each test in the menu is typically associated with a specific code, known as a CPT (Current Procedural Terminology) code, which is used for billing and insurance purposes.

It's important to note that the specific tests included in a lab's test menu can vary based on the lab's capabilities, specialties, and the needs of the patients and healthcare providers it serves.

Presumptive Testing

This involves initial screening tests for various substances. The CPT code used for this is 80307. The 2023 Medicare rate for this code is $62.14.

Definitive Testing

This involves more specific and sensitive tests to confirm the presence of particular substances. The CPT codes used for this depend on the number of drug classes tested¹:

1. For 1-7 Drug Classes: G0480, with a 2023 Medicare rate of $114.43
2. For 8-14 Drug Classes: G0481, with a 2023 Medicare rate of $156.59.
3. For 15-21 Drug Classes: G0482, with a 2023 Medicare rate of $198.74.
4. For 22+ Drug Classes: G0483, with a 2023 Medicare rate of $246.92.

Let's discuss the above steps in detail, Read on for Part -3