Pathology/Lab Coding Alert

Question: I bill for an independent pathologist's professional services, which he performs at a hospital lab that does the technical work (slide prep, etc.). When the pathologist reviews a bone marrow biopsy case that involves decalcified tissue and iron stain slides, how should I code it? Do the decalcification and stain services have a professional component that I should report, or should the hospital lab be the only entity to bill for those, since the hospital histotechnicians prepared the decal and the stained slides? 

Texas Subscriber
 
Answer: You should bill for the professional component of each service that the pathologist provides. Append modifier -26 (Professional component) to each CPT code to indicate that you are billing only for the pathologist's professional service.

Although the hospital histotechnicians perform the decalcification and the special staining, the pathologist directs the work. Typically, the pathologist grosses the specimen and determines how the lab techs should process it for examination. Finally, the pathologist examines, interprets, and reports on the special stains and other slides prepared from decalcified tissue. All of those steps comprise the pathologist's professional service.

You should report this case for your pathologist as follows: