Wiki Npi/ptan

[jessica_hall1]

Sorry in advance if this is a stupid question - I have just recently started working in more of the billing aspect of the office as opposed to just the coding side so I'm a little confused about all of this! I've never worked denials before so this is all new to me! I work for a GI physician, who also has a pathology lab in his office to process specimens from his surgeries. We just recently started billing pathology to Medicare, and everything so far has been denied. The lab has it's own NPI number, does it also need it's own PTAN or do I use the PTAN registered to the physician? The denial codes for the services - CO and B7. Again, sorry in advance and I greatly appreciate any help/feedback you all may have for me!

Jessica Hall, CPC-A

 

[erjones147]

I was in roughly the same boat as you about a year ago, and here's what I learned (we currently only bill Medicare for -QW labs, but we are working on getting our CLIA complexity raised to moderate testing):

Does your lab have a CLIA number?

If so, are you certificated for the proper complexity of the tests you are running, and/or are you certified as a reference lab with Medicare (via an 855I application)?

Are you transmitting the CLIA number with your claims?

Are you appending the proper modifiers (-QW, -90, etc.) onto your CPT codes?

I do not know if the lab needs its own PTAN; I would be interested in that answer myself