88331-26 by different physician

kewing

Networker
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Hi All.

Looking for some assistance with this situation. Non-medicare patient, 88331 global is billed by one physician. Slides sent to outside pathologist (not in the same group as the original physician) for an opinion. Pathologist bills 88331-26-77. Insurance does not like -77; says we need a specific modifier to get this paid (of course, not divulging the secret modifier). I'm inclined to use modifier -59, but I have never tried to use it when different physicians are performing the same procedure.

I appreciate any and all answers.

Thanks.

Karen
 

jowatson

New
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First I would have to ask, why is the outside pathologist billing another 88331 instead of 88321, since slides were sent to them for an opinion? The outside pathologist did not do the initial intra op service on the block during the surgery, correct? So since the primary service was already billed as a global 88331, I don't see how the outside pathologist could bill the same service, but instead should bill the consult 88321. I could be wrong...just saying

JoNell

Hi All.

Looking for some assistance with this situation. Non-medicare patient, 88331 global is billed by one physician. Slides sent to outside pathologist (not in the same group as the original physician) for an opinion. Pathologist bills 88331-26-77. Insurance does not like -77; says we need a specific modifier to get this paid (of course, not divulging the secret modifier). I'm inclined to use modifier -59, but I have never tried to use it when different physicians are performing the same procedure.

I appreciate any and all answers.

Thanks.

Karen
 

kewing

Networker
Messages
42
Best answers
0
First I would have to ask, why is the outside pathologist billing another 88331 instead of 88321, since slides were sent to them for an opinion? The outside pathologist did not do the initial intra op service on the block during the surgery, correct? So since the primary service was already billed as a global 88331, I don't see how the outside pathologist could bill the same service, but instead should bill the consult 88321. I could be wrong...just saying

JoNell
Now that's and a-ha moment. Thanks. :D
 
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