Wiki 88304-26

[janrod.1989@outlook.com]

I work for a hospital. I'm confused because we are billing pathology code 88304 on ub04 for the facility and we are billing 88304-26 on CMS 1500 for the interpretation. ABC is denying the professional component saying payment is included in the facility reimbursement. Don't understand why if we are billing components separately? Help please

 

[SharonCollachi]

Well, hospitals don't bill on CMS1500, providers do. Can you tell us a little bit more about what you're doing?

 

[janrod.1989@outlook.com]

Well, hospitals don't bill on CMS1500, providers do. Can you tell us a little bit more about what you're doing?

So we have a provider billing team and a hospital billing team. We are billing pathology codes and they are denying by a commercial insurance stating payment is included in facility payment. Two claims are being billed a ub04 and a cms1500. Ub04 is paying. CMS 1500 is the one that is denying. Example 88304-26 is what we are billing for the provider. POS is 22 for both claims. Provider doing the reading works in the hospital aswell as the one doing the technical side of it.

 

[SharonCollachi]

I don't do facility billing, so I am way out of my league here, but on the face of it, it looks like the facility is billing for both the technical and the professional, and the doctor is also billing for the professional. From what very, very little I know, you do use modifiers on the facility side, don't you? A 88304 without a modifier means both the technical and the professional.

 

[janrod.1989@outlook.com]

I have heard of that. And it does sound right. I'm just not sure if they are using tc on the facility charges or not. I would have to check on the claims. Thanks