I previously worked for an independent lab, was laid off, and have recently been thrown into the world of hospital laboratory billing. Which I am learning is much different from an independent lab.
There is the hospital lab that bills clinical charges and a pathology lab group that bills the professional charges. The pathology lab association to the hospital lab is unknown to me.
Question 1: Does the pathology lab association to the hospital effect place of service?
Recently the pathology lab has been billing on a 1500 form CPT 84165 with a 26 modifier and 86334 with a 26 modifier under place of service 11 due to the patient was drawn at a physicians office. Medicare is denying.
Question 2: Is place of service 11 appropriate in this situation?
CPT 84165 is also getting billed under the hospital lab globally on a UB form.
Question 3: Is it appropriate to be billing 84165 globally and with a 26 modifier? If you are familiar with Pagets they say you can, but to me it only sounds appropriate in certain situations.
Any help is appreciated. I have been in the lab industry for over 10 years, but hospital billing makes me feel like I am drowning!
There is the hospital lab that bills clinical charges and a pathology lab group that bills the professional charges. The pathology lab association to the hospital lab is unknown to me.
Question 1: Does the pathology lab association to the hospital effect place of service?
Recently the pathology lab has been billing on a 1500 form CPT 84165 with a 26 modifier and 86334 with a 26 modifier under place of service 11 due to the patient was drawn at a physicians office. Medicare is denying.
Question 2: Is place of service 11 appropriate in this situation?
CPT 84165 is also getting billed under the hospital lab globally on a UB form.
Question 3: Is it appropriate to be billing 84165 globally and with a 26 modifier? If you are familiar with Pagets they say you can, but to me it only sounds appropriate in certain situations.
Any help is appreciated. I have been in the lab industry for over 10 years, but hospital billing makes me feel like I am drowning!