Wiki Prostate Biopsy

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nkorab

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Hi, All.
Our office is being asked by the pathology company to contract with them to bill for the biopsies to the insurance companies instead of us sending our biopsies to them.
We never billed for the 12 cores. We were told to bill 88305 x12, if we used 12 core kit. Does anyone else bill for these? Are these in addition to our 55700, 76872, and 76942?
Any help would be greatly appreciated.
Thanks, Nancy
 
If its Medicare you would report G0416 x 1 I'm not sure about commercial. Ill let someone else advise on billing but I don't think you can bill for it yourself if your doctor is not a pathologist
 
We are not going to bill any medicare patients. Only commercial plans. It seems to me that the pathology lab does not want to deal with billing these plans. We will still send specimens to them for interpretation, but they are not billing the insurance, we will.
Just did not know how to do this.
Thanks for your input on medicare though.
 
Sounds fishy. I'm not sure your physician can bill for pathology codes for services he did not perform. Sounds like they just want to push the hassle of billing these on someone else and make it your problem. They are commercial policies that adopt Medicare coding guidelines so id watch out there too
 
My thoughts exactly. They are going to perform the lab service but wants a separate contract as an"independent contractor" so that they bill us a lower fee than what the insurance would have paid them. I think they are avoiding all the referrals or prior auths that may be associated with getting payments.
I am not sure it is worth our efforts, especially since I am really not sure how to bill for these services.
Thanks for your input.
 
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