Pathology/Lab Coding Alert

Question: When can I bill for the professional component of decalcification? This seems like a purely technical procedure. Should I bill the professional component only if the pathologist actually does the decalcification?

Montana Subscriber

Answer: The Medicare Physician Fee Schedule does list payment amounts for a technical and professional component of decalcification code +88311 (Decalcification procedure [list separately in addition to code for surgical pathology examination]). If you bill the code without a modifier, you are claiming payment for the global service -- both the technical and professional fees.

Although decalcification seems like a purely technical procedure, billing the professional component does not mean that a pathologist performed the technical portion of the work by placing the specimen in the decal solution, for instance. Rather, the professional service includes the pathologist's oversight and direction that the specimen requires decalcification, and the pathologist's interpretation, which takes into account unique characteristics of decalcified-tissue slides. For instance, the pathologist might see decalcification artifacts on the slide and then interpret and diagnose the tissue accordingly.

Independent labs usually perform and bill the global decalcification service, requiring no modifier. But when two separate entities perform and bill for the surgical pathology service, including the decalcification, the lab that prepares the tissue should append modifier TC (Technical component), while the pathologist who examines and interprets the slides should append modifier 26 (Professional component).

Exception: Medicare doesn't usually require modifier TC for hospitals billing the technical service for an inpatient or outpatient on a UB-04 claim form.

Document add-on: Remember that decalcification is an add-on code. That means you can't bill for 88311 unless you-re also billing for the surgical pathology examination involving the decalcified tissue. The most common specimens that require decalcification include bone, plaque and sometimes breast tissue with extensive calcifications.

Your pathologist should note the decalcification in the pathology report. For instance, the gross description might say, "submitted in two blocks following decalcification." You should only report the decalcification once per specimen regardless of how many blocks or slides the pathologist examines.