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Gwcobgyn

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Hello , I work for an OB/GYN practice and we just started working with an outside lab to bill for lab tests. This is the my first experience billing for lab services.
1. Does anyone know if we need a modifier attached to the CPT for labs? The lab sent a list of Lab Test codes and corresponding CPT's.
2. Some of the Test codes are for panels and have multuiple CPT's.
Do we need an additioanl modifier for these?
3. Last question should we bill lab work seperate from physicians visit?
We do have an agreement with the lab to bill us and we bill insurance.
Sorry for the long post and I woulld appreciate any help anyone can give on this!
 
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In my 16 yrs of lab billing it is customary for the lab to bill for the labs performed. On occasion the lab may bill the charges back to the doctor's office, hence the doctor's office would bill the patients or insurance, usually done if the doctor and lab have that agreement. Otherwise the doctor's office would not be billing for the labs.

What are the panels? What modifiers do you think you need? Lab billing only uses a hand full of modifiers.

Hope this helps.
 
We do have an agreement with the lab to bill us and we in turn bill insurance. Only BCBS right now. Their are several panels however one of the most frequent we use is Prenatal Panel. We were told by one of the lab reps that works with our account that we may need a modifier, but they were not sure. She mentioned maybe using modifier 25 on all codes after the initial code on the panel. When I tried to research this the only information I found was on using modifier 90 but it looks that would only apply if we were just billing for the veniuncture.

Thank you very much for your reply and any help you can give will be appreciated.
 
Hello Gwcobgyn and Mbella
Here are lab test we use and corresponding dx if provider's orders documented

CPT LABS
Urines 81001-81003 Dx I10 N39.8
81025 Pregnancy DX N77 Z13
84153 PSA Prostate DX Z12.5 R39.1 N42.9 Z13.89 R97.2
84402 Testosterone DX E28 N52
If lab test repeated same day use modifier 91 on 2nd lab code. The modifier 25 is only used on Eval Mgnt CPT 99202-99215 for office visits which have more ancillary or other treatment same day as office visits. Labs, injection, xrays, Etc added on same day as health medical visit.
Lady T
 
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