Revenue Cycle Insider

Question: Our lab just brought on a new client, and a lot of the specimens they are sending in are not really specimens, but a container labeled with the patient's name and a folded gauze pad. After scraping both sides of the submitted gauze pad, we have not been able to identify any tissue, even though the lab is still performing a hematoxylin and eosin (H & E) stain.

What should I do to code this situation? I have the lab pushing back that it should be at least paid for its technical services; I agree the lab should be reimbursed for its work, but I think there is nothing to charge.

AAPC Forum Participant

Answer: In such cases, there is probably nothing you can do to get reimbursed for the service, as it would be unethical for you to bill for a service that you are not actually providing. You may be attempting to prepare the stain, but as you cannot use the sample, you cannot provide a result or a report to accompany it. To put it simply: You cannot claim you have tested a tissue sample when there is no tissue sample to be tested. That means you cannot charge for the work.  

However, you should bring the situation to the attention of the provider who is sending samples that your lab cannot process. You could, perhaps, charge them a nominal fee for any sample that you begin, but cannot finish, processing. You could accompany that with a report explaining why you could not follow through with the service. But you should not bill using a CPT^Ò code for the service, even one with a 26 (Professional component) or TC (Technical component) modifier appended to indicate you are only charging for a specific part of the service.

Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC