Hello and Welcome! Labtech Diagnostics is excited to partner with Pellecome in providing patients and physicians the most reliable, timely, accurate, and cost effective hormone testing services. We’ve designed this brochure to compile all the information you and other staff members need to facilitate the testing process from beginning to end. Please take time to review everything provided and keep in a convenient location for future reference. This Packet Includes: Sign-up Form (Please Fill & Return) Supply Information Supply List Pricing Sample Requisition Packing/Shipping Guide Sample Report FAQ Quick Contacts If anyone in your office has any questions about the information provided please let us know. We are happy to help in any way! Sincerely, Labtech Diagnostics Team Labtech Diagnostics | 1502 E Greenville Street, Anderson, SC 29621 | p 864.760.0039 ext.120 | f 864.760.0051 [email protected]
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Hello and Welcome!...Hello and Welcome! Labtech Diagnostics is excited to partner with Pellecome in providing patients and physicians the most reliable, timely, accurate, and cost
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Transcript
Hello and Welcome!
Labtech Diagnostics is excited to partner with Pellecome in providing patients and physicians the most reliable, timely, accurate, and cost effective hormone testing services. We’ve
designed this brochure to compile all the information you and other staff members need to facilitate the testing process from beginning to end. Please take time to review everything provided and keep in
a convenient location for future reference.
This Packet Includes:
Sign-up Form (Please Fill & Return)
Supply Information
Supply List
Pricing
Sample Requisition
Packing/Shipping Guide
Sample ReportFAQ
Quick Contacts
If anyone in your office has any questions about the information provided please let us know. We are happy to help
in any way!
Sincerely,
Labtech Diagnostics Team
Labtech Diagnostics | 1502 E Greenville Street, Anderson, SC 29621 | p 864.760.0039 ext.120 | f 864.760.0051 [email protected]
Account Executive: Dawn Deboskey & Vanessa Hoehne
Sign up date: _______________________________________
Account Information:
Practice Name: ______________________________________________
Upon initial setup, Labtech will provide you with draw supplies and shipping materials. With the email provided on the sign-up sheet, we will assign you a
Username and Password to order supplies easily on
www.labtechdiagnostics.net
Once you have logged in, you will find the tab named "Supplies" to make your order. The system will save your information each time you login,
Test ID Test Name CPT Cost2110 Estradiol, Serum 82670 5.00$ 70195 Testosterone, Free & Total 84402 - 84403 12.00$ 8129 Testosterone, Bioavailable 84402 15.00$ 2060 Progesterone 84144 8.00$ 8036 DHEA-Sulfate 82627 10.00$ 2120 FSH 83001 5.00$ 1002 CBC With Differential 85025 5.00$
60.00$
**Please Note**We encourage the drawing of patients at your office, but if a draw center is being used, please notify us so we
can contact them. A $35 draw fee will be applied for each patient draw done at a draw center.
Draw Fee 35.00$
Male Patient BloodworkPre-Insertion Labs
Test ID Test Name CPT Cost70195 Testosterone, Free & Total 84402 - 84403 12.00$ 8129 Testosterone, Bioavailable 84402 15.00$ 8036 DHEA-Sulfate 82627 10.00$ 7066 Vitamin D (25-Hydroxy) 82306 12.00$ 9280 Sex Hormone-binding Globulin 84270 10.00$ 4260 Lipid Panel 80061 5.00$ 4290 Comprehensive Metabolic Panel 80053 7.50$ 1002 CBC With Differential 85025 5.00$ 2010 TSH 84443 4.00$ 2005 T3, Free 84481 4.00$ 2000 T4, Free 84439 4.00$ 480947 PSA Total & Free w Ratio 84153 16.00$ 4082 CRP, C-Reactive Protein 86140 4.00$ 31789 Homocysteine, Serum 83090 16.00$
124.50$
Male Patient BloodworkPost-Insertion Labs
Test ID Test Name CPT Cost70195 Testosterone, Free & Total 84402 - 84403 12.00$ 8129 Testosterone, Bioavailable 84402 15.00$ 2110 Estradiol, Serum 82670 5.00$ 8036 DHEA-Sulfate 82627 10.00$ 1002 CBC With Differential 85025 5.00$ 480947 PSA Total & Free w Ratio 84153 16.00$
63.00$
**Please Note**We encourage the drawing of patients at your office, but if a draw center is being used, please notify us so
we can contact them. A $35 draw fee will be applied for each patient draw done at a draw center.
The ordering provider is responsible for determining the medical necessity of clinical laboratory tests and for assigning and providing specific ICD-10 code(s) to support the medical necessity of the laboratory tests.
PLEASE SELECT A PROFILE, PANEL OR INDIVIDUAL TEST BELOW
Name (LAST, FIRST, MIDDLE)
Address
City, State, Zip
Date of Birth: Sex M F
Phone Number Social Security #_______/_______/_______
BILLING INFORMATIONInsurance Information:
Bill: Client Insurance PatientFor insurance billing, attach patient’s facesheet, copy of insurance card, and all applicable diagnosis codes
SPECIMEN INFORMATIONCollection Date:______________________ Time:___________ AM PM
Fasting Yes Hours:__________ No
*Test has limited coverage
*Limited to 60 allergens per order
Labtech Diagnostics 1502 E. Greenville St., Anderson, SC 29621 • PH (864) 760-0039 • FAX (864) 332-9804 • HOURS: Mon-Fri 6:30am - 5:30pm, Sat 8am-12pmPLEASE SEE PANELS AND PROFILES TEST COMPONENTS ON THE BACK PAGE, CROSS OUT ANY UNWANTED TESTS
Female Post-Insertion (1 SST, 1 LAV)(SG:195)Testosterone, Free & Total, Testosterone, Bioavailable, Estradiol, DHEA-Sulfate, CBC W Diff, PSA Total & Free w/ ratio
X
THINPREP PAP (58315)
Step 1
Slightly tear white inner lining of bag.
Step 2
Slightly tear white inner lining on other side.
Step 3Gently slide Labtech Diagnostics shipping box into the bag. (should be a tight fit)
Step 4Tear off protective liner and seal the bag. Place the label on the FedEx bag.
Should you have any questions, please call client services (864)760-0039 ext. 130 or 131
You can request more shipping boxes, bags, and prepaid shipping labels in the provider portal at www.labtechdiagnostics.net when you order more supplies.
Pat
ien
t
Name:
Sample, Patient
(864)333-7777Phone:
001Patient ID #:
Fasting Status: Yes
Gender:
MaleBirth:
4/8/1979Age:
40File ID:
Sp
ecim
en Collection Date:
Received Date:
3:58 PMCollection Time:
121Specimen ID:
Report Type:
Report Date:9/9/2019
9/9/2019
Complete
9/11/2019 Do
cto
r
Doctor: Pellecome ClientPellecome ClientAddressPhone Number
<4 ng/mL0.365 PSA, 3rd GenThis test was performed using the Roche CobasElectrochemiluminescent method. Valuesobtained from different assay methods cannotbe used interchangeably. PSA levels,reagardless of value, should not beinterpreted as absolute evidence of thepresence or absence of disease.
<0.86 ng/mL0.134 PSA, FreeThis test was performed using the Roche CobasElectrochemiluminescent method. Valuesobtained from different assay methods cannotbe used interchangeably. Free PSA levels,reagardless of value, should not beinterpreted as absolute evidence of thepresence or absence of disease.
Page 2 of 2 LABTECH DIAGNOSTICS, 1502 E. Greenville St. Anderson, SC 29621 PH (864) 760 0039
001
Pat
ien
t
Name:
Sample, Patient
(864)333-7777Phone:
222Patient ID #:
Fasting Status: Yes
Gender:
FemaleBirth:
9/12/1975Age:
43File ID:
Sp
ecim
en Collection Date:
Received Date:
9:18 AMCollection Time:
122Specimen ID:
Report Type:
Report Date:9/9/2019
9/9/2019
Complete
9/11/2019 Do
cto
r
Doctor:Pellecome Client Pellecome ClientAddressPhone Number
0.5-1.2 mg/dL0.7 Creatinine, SerumFor patients >49 years of age, the referencelimit for Creatinine is approximately 13%higher for people identified asAfrican-American.
9-23 RatioSee NoteBun/Creat RatioBUN/Creatinine ratio is not applicable.
Page 2 of 3 LABTECH DIAGNOSTICS, 1502 E. Greenville St. Anderson, SC 29621 PH (864) 760 0039
FAQ’S HOW WILL LABTECH DIAGNOSTICS BILL FOR PELLET HORMONE THERAPY LAB SERVICES?
Labtech has created very competitive client pricing to be billed to you, the provider. You can include the costs of these in your fees to the patient for pellet hormone therapy services.
WHAT IS THE CLIENT PRICE FOR A SPECIFIC TEST?
For the price of a test not listed on the price list in the brochure, you can request it at www.labtechdiagnostics.net, login in the top-right corner with the provided login info; on the dashboard, click “Request Test Price”. A billing representative will reach out to you.
You can also call (864)760-0039 ext. 112, Nadia.
CAN I SEND MY PATIENT TO A DRAW CENTER?
We encourage the drawing of patients at your office, but if a draw center is being used, please notify us so we can contact them. A $35 draw fee will be applied for each patient draw done at a draw center.
Please email [email protected]; Mobile: (864)202-2574 to notify of draw center location being used.
WHAT SUPPLIES WILL I BE RECIEVING?
A list of supplies is included in the brochure. There should be enough supplies for up to 12 shipments and 25 pre-insertion and post-insertion draws. If more supplies are needed, please login the web portal to order more.
CAN I INCLUDE MORE THAN ONE SPECIMEN PER SHIPMENT?
Yes, you can include 5-6 patient specimen per box.