Question Billing for 84153-26 and/or 99212 ?

cinike

Contributor
Messages
12
Location
Rye Brook, NY
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My doctor did the following:

1) Sent a patient to a lab for a blood test.

2) Received a blood test report from the lab.

Questions:

A) Can my doctor bill 84153-26 for reading, evaluating
and discussing the report with the patient?

B) Can my doctor bill 84153-26 and an E/M code (99212)
for the same date of service?

Thanks!
 

danachock

Guru
Messages
214
Location
Brainerd, MN
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0
Hi cinike,
Sending a patient to the lab for a PSA 84153 does not allow your provider to bill 84153-26.
Please refer to your guidelines in our ICD book. They have rules for inpatient and outpatient for "abnormal lab results". IF that is what we are dealing with.
Billing modifier 26 will result in a claim rejection or even a denial for "improper use of modifier or modifier missing" EOB adjustment code.
(This is pure speculation on this process with out actual documentation) but, when a patient is being seen by their physician for their results you would bill an office visit. If lab was done the "same day", you would bill that also with collection of blood ~ typically 36415.
But, I am wondering why was the lab ordered? Was it screening or diagnostic? If it is diagnostic bill 84153 otherwise if screening you would bill G0103. If it was ordered as a screening still bill G0103 along with abnormal results that the provider "interpreted".
Thanks for listening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
Coding Analyst (May 2018 - present), Laboratory, Pathology, Anesthesia Coder, Denial Specialist
 
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