Pathology/Lab Coding Alert

Question: When our pathologist receives a request for interpretation of a serum protein electrophoresis, should we bill his work as a consultation using 80500?

Tennessee Subscriber

Answer: No, you should not bill a pathologist’s interpretation of protein electrophoresis using 80500 (Clinical pathology consultation; limited, without review of patient’s history and medical records). 

Special instructions: The lab bills the technical lab test as 84165 (Protein; electrophoretic fractionation and quantitation, serum). If the ordering physician requests an interpretation, and the pathologist renders a medical opinion and writes a report, you should bill the interpretation as 84165 with modifier 26 (Professional component) attached. 

Medicare lists this code and about 20 others on the Physician Fee Schedule (PFS) with modifier 26 to describe the professional interpretation of the test. To pay for the technical lab test, Medicare lists 84165 on the Clinical Laboratory Fee Schedule. 

Here’s why: CMS identified about 20 clinical lab tests for which physicians commonly request an interpretation, and created this special payment mechanism. 

If a treating physician requests that your pathologist consult on an abnormal lab test result that isn’t one of the codes listed with modifier 26 on the PFS, then you may use the code you mentioned, 80500, to capture the service. 

As with the interpretation service, using 80500 requires a request, medical judgment, and a report. Additionally, the consultation must relate to a test result that is outside of the normal range, or you cannot report 80500.