Requisition Form

The link to our requisition form will allow you to view and print out the form if your system has Adobe Acrobat.

The requisition is the key communication and documentation tool accompanying specimens you send us.  Office or nursing staff who are already overwhelmed with paperwork may see the requisition as more nuisance paperwork. The real nuisance comes if the req is not properly filled out, and we besiege you with phone calls and returned specimens. This piece of paper is the only way we are made aware of your intentions and instructions, your patient's demographics and billing information. In many cases we cannot begin processing specimens you send until we have all the information, so incomplete information means delays for you and the patient. We do not have the benefit of seeing the patient, talking to your doctor ahead of time, or having access to your patient's insurance information: we are at your mercy on these accounts.

We will periodically refer back to our req to illustrate the key features and essential information. Most requisitions are similar and require the same basic information; I realize it is difficult to keep all the paperwork straight for all the labs you work with. I hope this discussion will help you through the confusion. It is important that we get the proper form (that is, PCNM would rather not have to translate a TriCore, SED or LabCorp form). Please understand that if you use an office-generated label affixed to our req that you may need to fill in additional elements, that may not be on your label. For instance, some labels do not include the patient's SSN, the clinician's name, and the date of service, and yet these are key information elements that we must have-or we cannot process the specimen.

Take a look at the requisition form:

It is divided into four key sections.  The first (across the top) is office and patient demographics.

The key elements here are patient name, DOB, SSN, physician name, and your own patient number (which we can put on our report form to aid you in your filing).

The next part, below and to the left of the demographic section, is the gyn cytology/tissue pathology information.

Key elements here include the Medicare/ABN block (which we will return to in a minute), patient history and clinical findings, especially LMP.

The right section, for non-gyn and tissue pathology,

allow for input of FNA information, level of suspicion, clinical history, source of specimen and special requests such as for slide recuts and report copies to be sent to designated providers.  If you choose to fill in the pre and post op diagnostic fields, realize that "pending pathology" is not an option! Rather, the point is what your clinician thinks the diagnosis might be after having performed the procedure -the doctor's preoperative impressions may have changed. These fields are designed for hospital cases, so are not key for outpatient cases. The surgical pathology portion allows for input of more that one specimen-there should be a separate entry for every specimen/container submitted.
 

The last part is the billing information.

Regarding billing issures...

We consistently see problems in two areas: 1) Advanced Beneficiary Notice (ABN) signatures, and 2) diagnostic vs. screening Paps. Refer again to the left upper section of the req under Gyn Cytology. Note the Medicare patient must sign for a screening Pap. Medicare considers a statement that "signature is on file" for the ABN as fraudulent; a new signature must be secured for every patient contact. If in doubt with the Medicare patient, have them sign. Remember to always indicate whether the Pap is screening, high risk screening, or diagnostic. Diagnostic Paps require an ICD-9 code-we are not allowed by Medicare to assign this code. Each of these categories requires a different V code and is not payable if not properly coded. We have prepared a laminated form to clarify the difficulties of categorizing a specimen as screening, high risk, or diagnostic. This quick reference form is available from our office.

A final note on the requisition...

Our Client Services Department deals daily with your office staff to recover information not placed on the requisition form. Unlike your office personnel, we do not see the patient, and do not have current patient data or the insurance card. We rely solely on you for that information, and we depend upon you to provide current information, as given by the patient at the time of service (as opposed to outdated system information). If we do not get the correct information up front, we end up having to call your office to get it updated, which creates more work for you in the long run, and results in unnecessary delays.

For surgical diagnoses, the pathologist makes the diagnosis and codes the case. For Pap smears, we are not allowed to do that. So, you need to provide the proper ICD code or clinical diagnostic information.