Pathology/Lab Coding Alert

Question: How should we charge for PhD interpretation of cytogenetic tests? Are there any codes we can bill for these non-physician interpretation services?

Texas Subscriber

Answer: CPT provides a code for cytogenetics interpretation (88291, Cytogenetics and molecular cytogenetics, interpretation and report), but it is a physician code, so you should not report it for a PhD. No other CPT code adequately describes the service when performed by a non-physician, so you cannot bill a separate code for the PhD service.

Fee schedules point the way: The Medicare physician fee schedule lists 88291 as a global-only charge, meaning that you can't use modifier TC (Technical component) to break out a technical charge for the service that a PhD could bill or modifier 26 (Professional component) to distinguish the physician work. Nor is 88291 payable on the clinical laboratory fee schedule. That means Medicare will only pay for 88291 as a physician service. An independent lab or hospital lab can't bill 88291 when a PhD alone interprets and reports the cytogenetics test, even if local state law allows licensed PhDs to perform the service.