Pathology/Lab Coding Alert

Question: Our pathologist performs a cervical conization specimen exam at our lab for a hospital patient. Can we bill Medicare directly for the entire service — technical and professional components?

Arkansas Subscriber

Answer: As a general rule, providers must bill the technical component (TC) of a pathology service to the referring hospital if the service date is during an inpatient or outpatient stay. The pathologist cannot bill the TC directly to Medicare.

That means you should bill the hospital for 88307-TC (Level V - Surgical pathology, gross and microscopic examination, Cervix, conization). The hospital will have a Part B provider number to bill the Medicare Part B contractor for the TC.

Professional component: You’ll need to make sure that the 88307 professional component is billed with modifier 26 (Professional component), because billing 88307 without a modifier indicates that the charge includes the technical and professional components. Unlike TC billing, Medicare rules don’t constrain whether the pathologist bills Medicare directly, or makes other billing arrangements with the hospital for the 88307-26 service.