FREQUENTLY ASKED QUESTIONS

Question: What are the recommendations for fasting instructions prior to collection of a fasting glucose or lipid profile?
Answer: Patient may have water. Black coffee with an artificial sweetener is also approved but no sugar, milk or cream. Unsweetened tea is approved. Lipid testing requires a 12 hour fast; other fasting tests require an 8 hour fast.

Question: What is Medicare’s position on payment for laboratory testing?
Answer: Medicare will pay only for tests that meet the Medicare coverage criteria and are reasonable and necessary to treat or diagnose an individual patient. Medicare does not pay for tests for which documentation, including the patient record, does not support that the tests were reasonable and necessary. Medicare generally does not cover routine screening tests even if the physician or other authorized test orderer considers the tests appropriate for the patient.

Question: Should I worry about medical necessity if my patient is not a Medicare patient?
Answer: The general guideline of ordering laboratory tests which are reasonable and necessary is appropriate for all University of Iowa Hospitals and Clinics (UIHC) patients. The Office of the Inspector General takes the position that civil penalties for Medicare fraud and abuse may be assessed if Medicare is billed for a diagnostic test that does not meet Medicare’s medical necessity criteria, or, if the patient’s medical record documentation does not support the diagnosis or symptoms listed on the diagnostic test requisition form.

Question: Is it better to order individual components of a Hemogram (CBC)?
Answer: The individual tests within a Hemogram (CBC) have not been subjected to the same rules as the Chemistry panels. Therefore, individual components of a CBC when more than two of the tests are needed is not cost effective.

Question: How should I order a Vitamin B12 Level?
Answer: The A-1a Pathology Doctor’s Order Form (Processed Stores #923533) has two ordering options:
Question: Is a UIHC G2d16 consent form required for Human Immunodeficiency Virus (HIV) testing when a staff member is exposed?
Answer: Please refer to the Appendix - Bloodborne Pathogens.

Question: How do I request that a Free Thyroxine (Free T-4) be completed only if the Thyroid Stimulatine Hormone is out of range?
Answer: By ordering a Thyroid Stimulating Hormone (TSH), Reflexive, if the TSH is outside the adult reference range, a Free T4 is automatically analyzed at an additional charge to the patient.

Question: How do I order an LDL?
Answer: A Low-Density Lipoprotein Cholesterol is automatically calculated when a plasma Cholesterol, Triglyceride and HDL Cholesterol are ordered together on the same specimen. The LDL Calculation cannot be done if the Triglyceride value is greater than 400 mg/dL. If the Triglyceride value is greater than 400 mg/dL, a Low Density Cholesterol (LDL), Measured should be ordered.

LDL, Measured requires a fasting sample. Non-fasting sample can be used, but they are slightly lower than fasting results. Correlation between calculated LDL and measured LDL is very good. Measured can be used for LDL (measured) non-fasting samples with Triglycerides > 400 mg/dL. If the triglyceride value is less than 400 mg/dL, the measured LDL cholesterol order will be canceled.