Please notify your patients that you are sending a specimen to Lower Columbia Pathologists. Informational forms are provided by Lower Columbia Pathologists for this purpose.

If the patient's insurance company requires a referral for pathology or nuclear medicine services, please obtain the referral before ordering the tests. Some insurance companies will deny payment if a referral is not obtained.

Contact the billing department if you have any questions about billing, insurance, or diagnostic information.

The following basic information is Required on Every Order:

Information Needed
  • Clinician's name
  • Clinic or hospital name
  • Date of service
  • Patient name
  • Patient birth date
  • Patient address
  • Patient phone number
  • Diagnosis information or code (see section below on diagnosis information)
  • Insurance billing information (see below)

If the required information is not provided on the original order, it will be necessary for us to contact your office.

Insurance Information

Please send copies of insurance cards, front and back, with the requisition. This is extremely important because insurance companies can have multiple plans and claims mailing addresses.

Lower Columbia Pathologists will bill all primary and secondary insurance companies if sufficient billing information is provided.

In addition to the information listed above, the following is required, depending on the patient's insurance coverage:

Commercial Insurance, IPA, PHO, HMO, Kaiser, Regence, Blue Cross, etc.
  • Copy of insurance card (front and back),


  • Name of insurance company
  • Address of insurance company
  • Insurance identification number
  • Group number
  • Employer
  • Insured's name if different than patient
  • Supplemental (secondary) insurance information
  • Medicare number including alpha characters
  • If welfare is secondary, the welfare ID number is required (PIC #, not the case #)
  • Supplemental insurance information (copy of card is preferred)
  • Pap smear waiver if ordering more than one routine Pap smear every three years
Medicare HMO
  • Copy of the insurance card


  • Insurance company name
  • Insurance company address
  • Identification number
Welfare (Washington or Oregon)
  • Copy of current month coupon


  • Welfare identification number, including all alpha characters (PIC # not Case #)
Medicare/Welfare Secondary
  • Medicare number
  • ICD-9 code (diagnosis code)
  • Signed Medicare waiver if pap smear is ordered
  • Welfare ID number
  • Copy of the coupon for the month of service
Healthy Option Plans and Basic Health Plans
  • Copy of current month coupon AND copy of insurance card


  • Insurance company name
  • Insurance company address
  • Identification numbers
Labor & Industries
  • Patient's social security number
  • Claim number
  • Employer Name
  • Date of injury
  • Type of injury
  • Address of labor and industry company if other than state

Diagnosis Information (required)

As a reference pathology laboratory, the requirements for ICD-9 (diagnosis) coding are the same as for clinical laboratories. The diagnosis codes, submitted on our insurance billings, must be based on the reason the test was ordered -- not the results of our testing.

When you send a specimen to our laboratory for testing, the order must include the reason for ordering the test (patient diagnosis). This information must be provided on the requisition form and submitted with the specimen, and must correspond with the main reason for ordering the test or procedure. Your office staff is not required to look up and assign the applicable ICD-9 codes. Our billing department can assign the correct diagnosis code based on the information you provide to us on the requisition.

The diagnostic information 


be provided in the form of 

  • Specific diagnosis codes
  • Signs
  • Symptoms
  • Patient Complaints

The diagnosis codes


be assigned based on these

  • Probable
  • Suspected
  • Questionable
  • Rule out

If the diagnostic information is not provided on the requisition form, we are required to call your office to obtain it.