Pathology/Lab Coding Alert

Answer: How you should report modifiers 26 (Professional component) and TC (Technical component) varies for different clinical laboratory and pathology procedure codes.

Key: Lab or pathology services may be broken down into a technical component (such as technician labor and materials involved in doing a procedure) and a professional component (such as interpreting the test findings and reporting relevant diagnostic information). Look at the following three examples to understand how to use modifiers 26 and TC to capture these work components:

88112 (Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal): If your lab performs both the technical work to prepare the slides and the professional work for the cytopathologist to interpret the slides, you should bill the global service, which means reporting 88112 without any modifiers. However, if a different entity provides one part of the service, you should bill just the part that your lab performs. That means reporting 88112-TC if you only prepare the slides, and 88112-26 if you only interpret the slides.

Tip: You should use modifiers TC and 26 in this way for most anatomic pathology or cytopathology services. You’ll see these codes listed on the Medicare Physician Fee Schedule (MPFS) with pricing for the global, technical, and professional services.

84165 (Protein; electrophoretic fractionation and quantitation, serum): This is a clinical laboratory test paid on the Clinical Laboratory Fee Schedule (CLFS), which you should report without a modifier when your lab performs the test. However, Medicare also lists 84165 on the MPFS with modifier 26. If your pathologist receives a request to interpret the results of an 84165 clinical lab test, you may separately bill the professional interpretation service as 84165-26.

Tip: Most clinical lab tests are technical-only codes and don’t warrant billing a separate interpretation service. Medicare lists just over 20 codes for payment on both the CLFS and the MPFS with modifier 26.

88174 (Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision): Most Pap tests result in a clear finding that the lab reports to the ordering physician, and Medicare pays for the test on the CLFS. However, the lab may sometimes request that a pathologist interpret the Pap test findings, and the pathologist may separately report this professional service. Unlike the other codes above, you won’t report the professional work using modifier 26. Instead, CPT^® provides a separate code that you should bill for the pathologist’s work, which is 88141 (Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician).