Billing 85025 & 85027 together - 2 different physicians, same acct #.

pookergirl

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Hello,

I code lab and path and this scenario comes up many times a day and only now is becoming an issue of debate. A patient will bring in 2 orders from 2 different physicians, one will be for a plain old CBC and the other order will be for a CBC with diff. The lab then draws both and runs them, minutes apart, the time the result post are usually less than 5 minutes apart. Both sets of results usually match or are just a couple decimal points apart in values. My thinking is, the more comprehensive CBC with diff should be the only charge in this scenario because one set of results suffices both physician orders. Both the CBC and CBC with diff are billed on the same account number. We were told today to look at the result time and if they are the same, have the CBC removed and if they are different, add a -59 mod to the CBC. It has always been my understanding if they are drawn at the same time and run a few minutes apart, we shouldn't charge both, only the more comprehensive code.

And how much time between the results would you then add a -59 to the 85027 code? An hour's difference between the 2? 20 minutes? 10 minutes?

I would appreciate any input from those who have run into this scenario.

Thanks so much,

KB
 
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