Repeat test on separate DOS

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Gibbons86
Posts: 11
Joined: Thu Mar 29, 2018 8:55 am

Thu Dec 17, 2020 9:03 am

I am trying to find guidelines regarding billing for repeat testing on separate dates of service. A provider performed a Covid Lab test 87426 prior to elective major surgery, but the surgery was rescheduled after the test was performed so the patient had to be re-tested for the same Covid lab test 87426 to be within 48 hours of the surgery. The provider wants to bill for both tests. What resource can I provide to support billing or not billing for the repeat test?

Personally I find it difficult to support the medical necessity of both tests, especially if it was due to provider scheduling and not a medical condition, but unable to provide that validation anywhere. We are required to have a negative covid test within 48 hours of any major elective surgery in the State of Iowa, so that is why the provider wants to bill both.

Thank you!
jeskla
Posts: 13
Joined: Wed Feb 12, 2020 8:30 pm

Mon Dec 21, 2020 11:18 am

For medical necessity, the CDC seems to leave the medical necessity to the physician to determine for repeat testing. Even though it's a scheduling issue, does the fact remain the physician thinks the patient should be retested prior to admission/procedure?

Perhaps you could just reference :
https://www.cdc.gov/coronavirus/2019-nc ... rview.html

For public health reasons, your public health official(s) or healthcare provider may advise specific people, or groups of people, to be tested. You should follow this advice. It is important to realize that you can be infected and spread the virus but feel totally well and have no symptoms.
Your healthcare provider or public health official may recommend that you are tested before being admitted to the hospital or before a procedure (e.g., pregnant people admitted for labor and delivery, surgery). This testing is to protect healthcare personnel and other patients.

Just my opinion, happy to discuss further.
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