Lab orders that arrive coded, checked and ready to bill

• 26.2%

  of one payer’s 294,870 lab claims used a “Z” diagnosis code that needed extra codes to justify the test.

  Source: (Leblow, Hamill & Beqaj, 2019)

• $2.95M

  in claims estimated to be at risk of denial because of those codes.

  Source: (Leblow, Hamill & Beqaj, 2019)

• 10.7%

  of the same claims didn’t meet Medicare’s coverage rules for the test.

  Source: (Leblow, Hamill & Beqaj, 2019)

• Order inside your own system

  Providers order from a connected EMR, EHR, LIS or provider portal, or from the CPOE web interface.

• CPT and ICD-10 on every order

  Each test carries its CPT code, and each diagnosis its ICD-10 code, with no manual lookup.

• Medicare coverage checks

  Every test and diagnosis pair is checked against the Medicare LCD or NCD that applies, before submission.

• LDS® scores at the point of order

  Each test shows its 0–10 score and testing indication, so low-relevance choices stand out.

• Custom menus and saved panels

  Set up your test menu and disease-specific panels, and save panels to reuse.

• Eligibility Check built in

  Add Eligibility Check to confirm the patient’s active coverage from the same requisition.

• Physician practices and clinics

  Order the right tests, with the right codes, without leaving your EMR.

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• Hospitals and health systems

  One coded, scored ordering workflow across every department.

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• Clinical laboratories

  Outreach orders that arrive complete and billable, with no follow-up calls.

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• EMR and EHR vendors

  Add scored test selection and medical necessity checks to your order entry.

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• Leblow L, Hamill T, Beqaj S. Use of Laboratory Decision System as a Test Utilization Management Tool in Clinical Settings, Current and Future Perspectives. Journal of Clinical Laboratory Medicine. 2019;4(1).

  Study type: Retrospective analysis of historical claims: 374,423 test claims (96,170 orders) from a reference laboratory and 294,870 claims from a PPO managing self-pay organizations, reviewed with the LDS® ranking system and Medicare LCD/NCD policies.

  • Payer study: of 294,870 lab claims, 10.2% carried an ICD-10 code that is always denied, and 10.7% would not have been supported by Medicare (8.9% failed an NCD, 1.8% an LCD).
  • 26.2% of claims used a “Z” ICD-10 code needing additional supporting codes; the authors estimated $2.95 million in claims could have been corrected had LDS® been used as an ordering system.
  • 4,783 claims were for a “General Health Panel” that Medicare and most payers would not cover, an estimated $228,388.

  Read the publicationRead our summary

• Beqaj S, Shrestha R, Hamill T. An Automated Clinical Laboratory Decision Support System for Test Utilization, Medical Necessity Verification, and Payment Processing. Interactive Journal of Medical Research. 2025;e46007. doi:10.2196/46007

  Study type: Peer-reviewed viewpoint article describing LDS® and summarizing the reference-laboratory claims analysis. The authors note that more systematic testing is needed.

  • Describes ordering through LDS®-backed computerized provider order entry, where each test carries a medical necessity score, testing indication, and ICD-10 and CPT codes.
  • Notes that providing the testing indication with each order can reduce manual submission of medical necessity documentation.
  • Concludes that more systematic testing is needed to evaluate effectiveness.

  Read the publicationRead our summary

Disclosure: the studies above were authored or co-authored by Medical Database personnel, including our CEO, Dr. Safedin Sajo Beqaj. They are retrospective analyses of historical claims; figures about orders that “could have been corrected” are projections of what LDS® would have recommended, not results measured after deployment. Individual results will vary.