Neurology & Pain Management Coding Alert

Question: I read muscle and nerve biopsy pathological interpretations in my lab, which is in my office. Which location code should I use -- lab or office? The lab has a separate CLIA number and certification.

Michigan Subscriber

 
Answer: Because your lab is separate but located in your office, the place of service (POS) code that would apply is 11 (office-location, other than a hospital, skilled nursing facility [SNF], military treatment facility, community health center, state or local public health clinic, or intermediate care facility [ICF], where the health professional routinely provides health examinations, diagnosis and treatment of illness or injury on an ambulatory basis).
 
The origination of the POS code for lab tests is based on where drawn instead of where the sample is tested. Therefore, because your office and laboratory are on the same premises, you will draw patient samples in your office.
 
And, the POS code 81 (independent laboratory) should not be used. Although you are certified, most likely it is not as an independent. Code 81 is used for a lab certified to perform diagnostic and/or clinical tests independent of an institution or a physicians office. It is also stated that if a doctor is billing for a lab service performed in his or her office, the appropriate code for a physicians office should be used. It is important to check with the Clinical Laboratory Improvement Amendments (CLIA) of 1988 to find out what type of certification your lab received.
 
Note: A list of state and regional contact numbers can be found by doing a CLIA search on www.hcfa.gov.