Wiki 85025 and 85060

[jnunez1275@gmail.com]

Hello,

Can you bill 85025 POS 11 and 85060 POS 81 on the same day??

 

[KimberlyStewart]

POS 81 is Independent Lab? We have an independent lab here, they are responsible for billing labs the physician orders.. is it the same for you?

 

[jnunez1275@gmail.com]

No...we had the office perform 85025 where abnormal finding were found and then the doctor sent it to Bio reference for further review and for a written report CPT 85060. However Medicare has done a recoupment on the payment they made to us for 85025 stating that the "service was furnished by another provider"

 

[KimberlyStewart]

CMS will only pay for CPT 85060 in an inpatient setting. Was the QW modifier used for 85025?

 

[jnunez1275@gmail.com]

No it was not...

 

[KimberlyStewart]

Does the lab usually bill for test? If yes they may of billed also. Or if the patient had another appointment with primary care??? just throwing what ifs out there? If you have not called Medicare I would, sometimes the reason for recoup given is not the reason for take back. I attached something I found this on CMS website, read under background. Let me know if this helps, you can email me on personal email. I enjoy researching for answers, and of course in the process I learn something new.. happy4lsu@hotmail.com

 

[jnunez1275@gmail.com]

Thank you so much for your help. I received further guidance from our senior coder and Bio reference would be entitled to the reimbursement. Thank for attaching the article above as well as this helps in clarifying.