Wiki Billing Pathology Services Globally

[iamtaf]

Our pathology slides are prep'd elsewhere but then read by our in-house dermatopathologist. To bill commercial payors, I assume I can still bill globally 88304, 88305, etc w/o any modifiers. Assume I would fill in our dermpath's name in block 17 and their NPI in 17b. Also assume block 20 would be "yes" but not required to fill in any $ amount. Outside prep lab's CLIA # would go in block 23. Outside Lab's name and address in block 32.

I'm having trouble getting our computer software to keep block 20 charges as blank but still reporting our global fee in block 24J. Any suggestions? Is the manner described above correct for a non-Medicare billing scenario?

Thanks
Cathy

 

[peachygirl]

Hello,
You cannot bill for the whole global service when your dr is just reading. If a slide is sent out and prepped elsewhere, and all your dr is doing is reading when it comes in, you would use -26 modifier. The rest of the 1500 can be left as it would normally be billed.
(TC) - append when all that is done is prep for a slide
(26) - append when slide is prepped elsewhere and dr just reads results
(global, no mods) - ONLY when your office does both prep and read (i.e. in-house pathology)

Each of these will have a different price (and paid different-see Medicare fee schedule), generally the global is the highest, followed by -TC codes, then lowest would be -26 codes.

Hope this helps!
Mallory E, CPC

 

[iamtaf]

Billing pathology globally

My inquiry relates to billing commerical payers for pathology when we are purchasing the technical component elsewhere and that entity does not have a contract with the carrier so we do the billing for both. According to Inga Ellzey this is allowed but wanted feedback from my peers at the AAPC.

Thanks,

iamtaf

 

[varera]

What you are describing is called pass through billing (hiding who performed a procedure or part of a procedure by billing their work). Billing globally for services that are split into separate PC and TC services is only possible when the PC and TC are furnished by the same physician or supplier entity.