Ob-Gyn Coding Alert

Question: In addition to our professional test fees, we bill for services on behalf of the lab we use. I received an EOB (explanation of benefits) from a carrier showing payment of under $10 for a Pap smear using 88164. When I called to contest the fee, I was told to use modifiers -26 and -27 to denote professional versus technical components, and would then be paid more. If we let the lab bill for its own services, should we bill just a specimen collection fee?

Massachusetts Subscriber
 
Answer: Your question is a good example of why practices should not provide free billing services for laboratories. You cannot charge for the billing service, you end up with all the paper hassle, and you dont 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 Q0091 (screening Papanicolaou smear; obtaining, preparing and conveyance of cervical
or vaginal smear to laboratory), if the patient is Medicare- eligible. 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. Your payer may interpret the code that way and reject your claim, but it is worth a try.