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Pathology/Lab Coding Alert

Reader Questions:

87207 Captures Stain Interpretation

Published on Tue Feb 08, 2011

Question: The lab performs direct and concentrated blood smear Giemsa stain to rule out malaria, and the pathologist interprets the stains. Should we report the pathologist's interpretation using consultation code 80500 in addition to the stain code?New Mexico SubscriberAnswer: No, you should not bill 80500 (Clinical pathology consultation; limited, without review of patient's history and medical records) in addition to the stain code (87207, Smear, primary source with interpretation; special stain for inclusion bodies or parasites [e.g., malaria, coccidian, microsporidia, trypanosomes, herpes viruses]).Here's why: Code 87207 is a "global code" that includes both the technical and professional components when you bill the code without a modifier. That means the pathologist's interpretation is included in the service, and you should not separately bill the interpretation using a consultation code.If you're billing only the pathologist's interpretation, append modifier 26 (Professional component) to 87207. When billing this service for the lab technical work, [...]
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