Pathology/Lab Coding Alert

Question: If the pathologist examines a pathology case, such as an adrenal resection, but the slides are prepared by the histology lab at the hospital and sent over to us, we attempt to bill just the professional component. We keep getting denials for these cases, which we would bill as 88307-PC. We don’t have a problem when we bill just the technical component with modifier TC. What are we doing wrong?

Iowa Subscriber

Answer: You’re correct to bill just the professional component of a pathology exam if your lab doesn’t do the technical work to prepare the slides. And you’re correct that you need to bill using a modifier for professional component. But that modifier is 26 (Professional component) not PC (Wrong surgery or other invasive procedure on a patient).

Tip: Although the modifier for technical component is TC (Technical component), the modifier for the other part of the service is 26, not PC.

So in your example of billing the professional component of an adrenal resection, you should bill 88307 (Level V - Surgical pathology, gross and microscopic examination Adrenal, resection …) with modifier 26.