Pathology/Lab Coding Alert

Question: When we bill for microorganism special stains on surgical pathology specimens, please explain how we should use modifiers TC and 26 and how that will impact our reimbursement.

Iowa Subscriber

Answer: The correct code for a special stain for microorganisms that your pathologist might use on a surgical pathology specimen is 88312 (Special stain including interpretation and report; Group I for microorganisms (eg, acid fast, methenamine silver)).

When you bill 88312 without a modifier, you’re billing for the global service. That includes both the technical component and the professional component of the work. The technical component includes steps such as preparing a tissue specimen on a slide with a specific stain, such as acid fast bacillus (AFB). The professional component describes the pathologist’s work to view and interpret the findings from the slide.

Medicare pays $113.05 for the global service (2021 Medicare Physician Fee Schedule (MPFS) national facility amount, conversion factor(CF) 34.8931).

If two separate entities perform the technical and professional components of the service and bill separately for their part of the work, that’s when you need to use the modifiers you mentioned.

If you’re billing for the technical component, you should report 88312 with modifier TC (Technical component), and Medicare will pay $86.19 for that work (2021 MPFS national facility amount, CF 34.8931).

On the other hand, if you’re billing for the professional component, you should report 88312 with modifier 26 (Professional component), and Medicare will pay $26.87 for that work (2021 MPFS national facility amount, CF 34.8931).

You can see that the technical and professional payments add up to the global pay.