Ob-Gyn Coding Alert

Question: We bill for services on behalf of the lab we use, in addition to our professional test fees. I received an explanation of benefits (EOB) from a carrier showing payment of less than $10 for a Pap smear (88164, Cytopathology, slides, cervical or vaginal [the Bethesda System]; manual screening under physician supervision). When I called to contest the fee, I was told to use modifiers -26 and -TC to denote professional versus technical components, and would then be paid more. If we let the lab bill for its own services, should we be billing just a specimen collection?

New Jersey Subscriber

Answer: Your question offers a good example of why practices should stop providing free billing services for laboratories. You cannot charge for the billing service, and you end up with all the paper hassle and do not even get paid appropriately. Let the lab bill for the services it performs.

You can try billing for the Pap handling as many practices do by reporting 99000 (Handling and/or conveyance of specimen for transfer from the physicians office to a laboratory) or, if the patient is Medicare-eligible, by reporting Q0091 (Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory). A literal reading of 99000 suggests that it should be used if a staff person from your practice had to physically transport the specimen to a lab, and your payer may interpret the code that way and reject your claim, but it may be worth a try.

The answers for Reader Questions and You Be the Coder were provided by Melanie Witt, RN, CPC, MA, an ob/gyn coding expert based in Fredericksburg, Va.