Approval Now Needed for Selected Mailout Tests

Effective Tuesday, June 26, 2012, during visit orders for selected mailout tests will require pathologist approval.  Mailout tests included are primarily genetic tests with slow turnaround time and/or very high charges. 

When the restricted tests are ordered on inpatient encounters, a prompt will show as follows:
Restricted Tests Prompt

An analysis of mailout test ordering patterns revealed a number of issues with inpatient mailout test ordering including:

Reimbursement:  On inpatient encounters, most reimbursement is by diagnosis related group (DRG) without specific coverage of diagnostic testing.  Patients may incur significant financial liability from charges associated with inpatient encounters, especially if insurance coverage involves high deductible or co-insurance coverage models.


There are circumstances where slow turnaround time tests are needed for inpatient management.  Example: infant in the Neonatal ICU with a suspected inborn error of metabolism who is expected to be in the hospital for months. However, analysis of ordering patterns has shown that currently many genetic tests are being ordered on short inpatient encounters, often when outpatient follow up was set up within a short span of time. 


Direct Billing:

Questions should be directed to Matthew Krasowski, MD, PhD, medical director of the Clinical Chemistry Laboratory (384-9380,