Pathology/Lab Coding Alert

Question: Our lab analyst performed a polarized light-microscopy exam of synovial fluid from a patient’s knee to evaluate for gout, but a pathologist who is not part of our lab interpreted the test and billed 89060-26. Should we bill 89060-TC?

Georgia Subscriber

Answer: No, you should not use modifier TC (Technical component), but should bill 89060 (Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid [except urine]) without a modifier. Even if a separate entity bills 89060-26 (Professional component), the payer should cover both services.

Here’s why: Most codes paid on the Physician Fee Schedule (PFS) are “global” codes that represent both a technical and professional component. If you perform only the technical component, you bill the code with modifier TC, and if you perform only the professional interpretation, you bill the code with modifier 26. If you bill the code without a modifier, you’re billing for both the technical and professional components.

Most codes paid on the Clinical Laboratory Fee Schedule (CLFS) are technical-only codes and don’t require a professional interpretation. Medicare has determined that handful of these tests, such as 89060, might require professional interpretation. CMS has put a different payment mechanism in place for the technical and professional services for those codes.

Do this: The lab that performs the technical part of the test bills the code without a modifier. In your case, Medicare will pay for 89060 based on the CLFS payment amount. However, Medicare also lists 89060-26 on the PFS with a payment amount that represents only the professional interpretation for the test.