Pathology/Lab Coding Alert

Question: We have a PhD performing molecular diagnostics and molecular array testing in our lab. How can we bill the interpretation -- the professional component of his work? Indiana Subscriber Answer: Medicare prohibits Part B professional fee payment to PhDs, instead limiting reimbursement to physicians (and certain other practitioners in some cases). Most states have laws restricting medical practice to physicians (such as M.D.s). That means a PhD can't legally render -- or bill for -- an interpretation service that involves "the practice of medicine." Medicare has given some direction for billing when PhDs perform molecular diagnostics and array testing, however. List arrays with TC: Codes 88384-88386 (Array-based evaluation of multiple molecular probes ...) include both a technical and professional component. You can only bill the professional work using a global charge or with modifier 26 (Professional component) when a physician (such as a pathologist) performs the work. According to the Correct Coding [...]