Canada Lab Fees

For Canada users, lab fees are treated just like ordinary procedures except for a few key differences. Lab fees cannot be attached to appointments directly. Instead they are attached to procedures, which then can be attached to appointments.

Setup

For procedure codes that are lab fees (99xxx), go to the Procedure Code and check the Is Lab Fee box.

Treatment Planning

  1. In the Chart Module, treatment plan the non-lab procedure.
  2. On the non-lab procedure's Edit Procedure Canada Tab, enter the lab fees (up to two can be entered). If the carrier supports version 04 e-claims, both fees are sent. If the carrier supports version 02 e-claims, then only one lab fee is sent.
  3. Click OK.

For each lab fee entered, one lab procedure with code 99111 is automatically created (beginning with ^^ to visually indicate it is attached). The lab procedures show in the Chart Module and the Account Module directly below the procedure it is attached to.

To remove a lab fee, edit the procedure and clear out the lab fee amount on the Canada tab. Lab fees can also be detached from procedures by right-clicking in the Chart module progress notes and choosing Detach Lab Fee.

If the lab fee is not a 99111 code, then the lab fees can be manually entered into the Chart and attached to a non-lab procedure by highlighting both procedures and selecting Attach Lab Fee. In this case, it will not show in the Procedure Code Edit window.

Insurance Estimates

Lab fee estimates are based on the coverage of the associated procedure.

Overrides to estimates must happen on the procedure rather than the lab.

When the insurance plan is a Category Percentage plan, the percentage will be applied to the total of the procedure and attached lab fees. Example: 50% coverage. Procedure fee is $100. Lab fee is $10. Estimate = (100 + 10) * 50% = $55

Claims

Lab procedures can be attached to claims.

For category percentage insurance plans, the lab fee will show as a separate line item on the Edit Claim window. See below for example.

For PPO percentage insurance plans, the lab fee will not show as a separate line item on the Edit Claim window but will still send to insurance.