Most Common Laboratory Tests Methods & Techniques

There are many different laboratory tests that are conducted throughout labs whether it is for research or clinical purposes. As scientific advances continue to grow, more and more tests are being created. However, some of the traditional laboratory tests include PCR, Western blot, protein extraction, get electrophoresis, FISH and growing bacteria. These experiments have a diverse way of how they are conducted, analyzed and what their purpose is for clinical testing.

PCR (polymerase chain reaction)

PCR is a fast and inexpensive technique used to “amplify” small segments of DNA. Molecular and genetic analyses calls for large amounts of sample DNA and without PCR amplification this would be nearly impossible. First, the sample that needs to be amplified is heated so that the DNA denatures (separates into two single stranded DNA pieces). Next, this creates the duplication of the original DNA and one new strand of DNA. Then each of these can be used to create two new copies, and so on. The cycle of denaturing and synthesizing new DNA is repeated as many as 30 or 40 times. Once amplified, the DNA created by PCR can be used in many different laboratory tests such as, detecting of bacteria or viruses, diagnoses of genetic disorders and DNA fingerprinting. Lastly, to conduct analysis of the PCR product you can stain the amplified DNA product with a chemical dye such as ethidium bromide and perform gel electrophoresis to visualize if the DNA is there. This allows for the determination of the presence and the size of the PCR product.

https://www.genome.gov/10000207/

Western Blot

Western blot is an immunoassay test method that detects specific proteins in the blood or tissue. Western blot is usually used as a follow-up test to determine the presence of an antibody and to help diagnose a condition. To perform a western blot test, a sample containing the protein is applied to a spot along one end of a layer of gel. Multiple samples and a control may be placed side by side along one end of the gel in separate “lanes.” An electrical current causes the proteins in the sample(s) to move across the gel, separating the proteins by size and shape and forming bands that resemble the steps of a ladder. These sample and control ladders are then “blotted” (transferred) onto a thin membrane that is put in contact with the gel. Labelled or tagged antibodies are then used in a one or two step process to detect the proteins bound to the membrane. The presence of the certain proteins is interpreted by comparison with known negative or positive control samples in the other lanes.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3456489/

FISH (fluorescence in situ hybridization)

FISH is a molecular testing method that uses fluorescent probes to evaluate genes and/or DNA sequences on chromosomes. FISH is useful, for example, to help a researcher or clinician identify where a particular gene falls within an individual’s chromosomes. The first step is to prepare short sequences of single-stranded DNA that match a portion of the gene the researcher is looking for. These are called probes. The next step is to label these probes by attaching one of a number of colors of fluorescent dye. When a probe binds to a chromosome, its fluorescent tag provides a way for researchers to see its location. These will allow the researcher to determine if there is a genetic abnormality such as, breast cancer or Down syndrome.

https://www.genome.gov/10000206/fish-fact-sheet/

Gel Electrophoresis

Gel electrophoresis is a technique commonly used in the lab to separate charged molecules, like DNA, RNA and proteins according to size. Gel electrophoresis includes preparing the gel made out of agarose gels, placing the gel in an electrophoresis tank and adding the buffer which conducts the electric current. Next, a dye is added to the DNA and a DNA marker is created which creates a ladder and as otherwise known as your control. The prepared DNA are carefully pipetted into the wells of the gel. Lastly, the electrical current is then turned on and shorter lengths of DNA will move faster than longer lengths. Once the DNA has migrated far enough across the gel, the electric current is turned off. The gel is then placed under an ultraviolet light to visualize the DNA. You can then estimate the size of the DNA in the sample by matching them against the closest band in the marker.

https://www.genome.gov/glossary/index.cfm?id=56

Growing Bacteria

Many factors affect how bacteria will grow. These include water, food/nutrients, oxygen, temperature, and pH. To grow bacteria, a petri dish is filled with agar. The agar will need to solidify. Then, a sterile swab is used to brush the bacteria on the petri dish. Lastly, the dish is put in an incubator. Many antibiotics have been created through growing bacteria. After a time, some bacteria develop resistance to an antibiotic, and it will no longer be effective against them. Because of this, scientists are always researching new antibiotics.

Protein Extraction

Because proteins are heterogeneous, there is no one method or reagent that is optimal for protein isolation. Protein purification is vital for the characterization of the function, structure and interactions of the protein of interest. The five key steps include extraction from biological material, separation from non-protein components, precipitation steps, and use of ion exchange chromatography to determine size. Protein extraction is essential for other techniques such as, Western blot. Also, this extraction can usually be done through automation. Biomolecules extraction is the first step that needs to be performed for the following analysis or manipulation process.

In all, laboratory methods are based on established scientific principles involving biology, chemistry, and physics, and encompass all aspects of the clinical laboratory from testing the amount of cholesterol in your blood to analyzing your DNA to growing microscopic organisms that may be causing an infection.

Sources:

Garibyan, L., & Avashia, N. (2013). Research Techniques Made Simple: Polymerase Chain Reaction (PCR). The Journal of Investigative Dermatology, 133(3), e6. http://doi.org/10.1038/jid.2013.1

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA and Ashwood ER, Bruns DE, eds. 4th edition St. Louis: Elsevier Saunders; 2006.

McAdam AJ. 2018. Total laboratory automation in clinical microbiology: a micro-comic strip. J Clin Microbiol 56:e00176-18. https://doi.org/10.1128/JCM.00176-18.

Procedural Coding Changes for 2019

The Centers for Medicare & Medicaid Services (CMS) developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B claims. The coding policies are based on coding conventions defined by various credentials such as the CPT manual, local and national Medicare policies and edits, coding guidelines, current coding practice, and standard medical and surgical practice. This upcoming year has many changes that affect laboratory coding, billing and payments. Specifically, this article will discuss the procedural coding changes for 2019 and the proposed changes in government reimbursement. In addition, there are relevant policies and issues affecting coverage. As well as, the impact of CMS editing systems. In turn, the changes provide the implementation of new codes and policies to influence patient care.

Procedural Coding Changes for 2019

The PAMA had their lawsuit dismissed against them after they were accused of having CLF’s changes incorrectly calculated. This was determined to not be true. Therefore, the CMS’s determination of payment rates cannot be challenged. Also, the ACLA Website filed an appeal on October 19 to Protecting Access to Medicare Act (PAMA). This included calling on Congress to reform and modernize the Clinical Laboratory Fee Schedule to ensure that beneficiaries can continue to access the lab sevices and diagnostics they need.

New Tier 1 Codes

Almost 50 new codes have been added for the 2019 year. Some of the new CPT codes include TERT, TGFBI, EZH2, BTK, PLCG2, MYD88, NUDT15, AFF2, AR, ATN1, ATXN1, ATXN10, ATXN2, ATXN3, ATXN7, ATXN8OS, CACNA1A, CNBP, CSTB, DMPK, FXN, HTT, PABPN1, SMN1, TBP, and PPP2R2B.

BRACA Coding

BRACA coding was determined to be one of the top 25 frequently paid laboratory tests. In 2017, Medicare spent $52M on this testing. There was a description revision which included BRACA1 (BRCA1, DNA repaired associated), BRACA2 (BRCA2, DNA repaired associated), (eg, hereditary breast and ovarian cancer) gene analysis; a full sequence analysis and full duplication/deletion analysis (ie, detection of large gene arrangements). In addition, description change also affects new and other indented codes. The two new CPT BRACA codes also have a price change depending on which code is ordered. For instance 81163 is $468 and 81164 (full duplication/deletion analysis) is $584. Lastly, there are parenthetical comments have been updated dependent upon which CPT is ordered.

New Panel Codes

The new panel code includes CPT 81443, which is genetic testing for severe inherited conditions. The genomic sequence analysis panel must include sequencing of at least 15 genes.

New MAAA Code

There are new MAAA codes that refer to infectious disease and oncology. The deleted MAAA Code is 0001M (Infectious disease, chronic hepatitis C virus (HCV) infection, six biochemical assays utilizing serum, prognostic algorithm reported as scores f or fibrosis and necroinflammatory activity in liver).

Quad Testing for Fetal Congenital Disorders

The CPT 81511 will utilize maternal serum to test for fetal congenital abnormalities.

Reconsidered Test Codes

This year two test codes went under consideration, which included 81326 and 81334. The 81326 CPT refers to PMP22 (eg, Charcot-Marie-Tooth, hereditary neuropathy with liability to pressure palsies). In addition, the 81334 CPT describes RUNX1 (eg, acute myeloid leukemia, familial platelet disorder with associated myeloid malignancy).

Proprietary Laboratory Analyses Codes

New PLA codes become effective in the quarter following their approval and publication. PLA test codes are released on a quarterly basis and published on the CPT public website at http://www.ama-assn.org/practice-management /cpt-pla-codes. PLA subsection includes ADLTs and CDLTs. CDLTs are defined by the Centers for Medicare & Medicaid Services (CMS) as tests that include blood tests, urinalyses, tests on tissue specimens, some screening and other tests. PAMA says ADLTs as covered under Medicare Part B that is offered and furnished only by a single laboratory. PLA 0018U through 0061U was added in the 2019 CPT and can be reviewed on the CPT or AMA website. These are carrier priced until discussed at annual clinical laboratory public meeting in July. Deleted PLA codes included several CPT codes. For instance, 0004U, which describes Infectious disease (bacterial). In addition, 0015U, which refers to Drug metabolism (adverse drug reactions), and 0020U which refers to Drug test(s), presumptive, with definitive confirmation of positive results, and any number of drug classes. Lastly, 0028U which describes CYP2D6 (eg, drug metabolism).

New Chemistry codes

Two new chemistry codes include 82642 and 83722. CPT 82642 refers to Dihydrotestosterone (DHT). Clinicians may order DHT testing for prostate cancer patients undergoing 5 alpha-reductase inhibitor therapy or chemotherapy (may need to monitor DHT serum levels for patients undergoing certain prostate cancer treatments). Lastly, CPT 83722, which describes a Lipoprotein, direct measurement; small dense LDL cholesterol. This may help identify patients with hereditary high LDL or LPA lipoprotein (a) deficiency. This deficiency is a key component in progression of atherosclerosis and cardiovascular disease

Fine Needle Aspiration Biopsy

Multiple new codes have been added for fine needle aspiration biopsy. Code reporting may be “mixed and matched”. However, imaging cannot be separately reported; it is bundled in the new codes. In addition, Modifier 59 will need to be reported when an add on code does not match the primary code. In addition, there was a deletion of 10022, which referred to imaging. Lastly, there are various payment changes dependent upon which CPT code is ordered.

Other Pathology

The MPFS achieved a victory when the CPT 85390-26 Fibrinolysis or coagulopathy screen, interpretation and report had a 104% increase to $38.21. In addition, there have been significant flow cytometry rate cuts. For example, 88185 (FC each additional marker) and 88187 (FC interpretation; 2 to 8 markers) cut by -19%. Also, 88184 (Flow cytometry first marker) cut by -3%. Lastly, IHC Morphometric Analysis showed positive and negative percentage impact dependent upon IHC manual and comput.

References:

https://www.ama-assn.org/practice-management/cpt-current-procedural-terminology

https://www.cms.gov/

NCCI Policy Manual for Medicare Services – Effective January 1, 2019

https://coder.aapc.com/

Laboratory Revenue Cycle Management: A Guide

The healthcare industry across the globe has undergone a huge transformation. Healthcare providers are now required to provide improved patient care while reducing operational costs. Whether it is a large hospital, an urgent care center or a private clinic, revenue cycle management has become an important factor in any practice for enhancing patient services and lowering expenses.

What is Revenue Cycle Management?

What is revenue cycle? The revenue cycle in laboratories involves managing patient registration and scheduling, coding diagnosis and procedures, collecting payments, and reviewing medical services. According to a recent study by Black Book Research (a healthcare analysis organization, 92% of top-level executives in healthcare sectors are now focusing on revenue cycle management (RCM). Focusing on your laboratory’s RCM is essential because studies have found that 30% of medical facilities are still not able to fulfill their yearly net revenue expectations.

Laboratory Revenue Cycle Challenges

Laboratory revenue cycle management is a complex process. A practice has to bear all the medical costs themselves before it can be paid in full by the patient or his or her insurance company. There are a number of factors that are critical for a better financial position of the lab, such as maintaining an accurate patient database, having a proper billing process, and improving point-of-service receivables. When these things are ignored, labs face a number of challenges:

A high number of unbilled claims
A high denial rate
Fluctuations in gross collection rate
Too many bad debts
Low monthly net collections
and many more…

Why Labs Need Medical Laboratory Software for RCM

Healthcare organizations need to deploy designated medical laboratory software for revenue cycle management. A RCM system can help to automate the administrative tasks, such as patient scheduling, reminders, payment information, and to reach out to insurance companies. Here are the benefits of using RCM software:

Optimized Billing Process: Calculating denial rate, net collection rate, first acceptance rate, A/R, etc., is time-consuming and prone to human errors. With a laboratory billing system, you can capture patient and service cost data to calculate everything automatically. With actionable reports on each aspect of the lab operations, you can quickly identify the problem areas and take actions accordingly.
Efficient Lab Operations: Centralizing lab database helps to standardize the lab operations, increases profitability, and opens new revenue opportunities. You get analytical information and reports from your medical lab software that enables you to get an overview of inefficient procedures and improve patient engagement to reduce unbilled claims and denial rates.
Meet Compliance Goals: Health systems often face mounting pressure due to ever-evolving compliance and regulatory environments. With protected and accurate patient and financial data in your RCM system, your practice stays compliant with healthcare regulations.

Prominent RCM System Vendor

American Soft. Solutions Corp. offers a comprehensive medical laboratory software – PROLIS – which has a billing solution integrated into it. It is a suitable option for automating your revenue cycle management process and streamlining core operations in your lab. You can even manage multiple labs such as toxicology lab, clinical facility, health system, pathology center at one place using PROLIS.

Conclusion

The revenue cycle of your health facility plays a significant role in driving profitability. Use medical laboratory software to make your revenue cycle management as smooth as possible and to improve the flow of revenue.