Wiki modifier 91

[phastings]

We are dermatologist clinic with a lab to process slides. We bill CPT 88305 globally when our lab processes the specimen and our doctor reads it. Often times our physicians will do multiple surgeries and will process and read some slides but will decide to send out one of the slides to a pathologist. In that case, we bill 88305 for the global specimens and bill 88305-TC for the slide sent a pathologist. In some cases we have to appeal because the 88305 ?TC is bundled into the 88305. We recently received a suggestion to not bill globally at all but to bill all our paths as 88305-26 and 88305-TC -91. Would this be an appropriate way to bill? Any suggestions?

 

[Ldari]

I don't think 26 and TC should be used together in this way... See this link to the WPS modifier fact sheet.

http://www.wpsmedicare.com/j8macpartb/resources/modifiers/modifier-tc.shtml

I worked at a hospital previously that billed the global service and had a contract to pay a separate pathologist in some cases. Outside of a contract arrangement I'm not sure what other options there are.