Pathology/Lab Coding Alert

Question: Our facility billed the global charge for 84165, but then the pathologist, who is not employed by us, billed 84165-26. I'm concerned that the insurance company won't pay us both. What's the correct way to bill this service if our lab performs the test but a separate pathologist interprets it -- should we use modifier TC?Washington SubscriberAnswer: No, you should not use modifier TC (Technical component). The insurer should pay for the test the way it was billed: Your lab bills 84165 (Protein; electrophoretic fractionation and quantitation, serum)The pathologist bills 84165-26 (... professional component). Here's why: Medicare splits payment for lab and pathology services into two fee schedules: the Physician Fee Schedule (PFS) for professional services, and the Clinical Laboratory Fee Schedule (CLFS) for technical clinical lab services. Most codes paid on the PFS are "global" codes that represent both a technical and professional component. If you perform only the [...]