Wiki Billing for Shave biopsy 11102 and 87207-26 -or- 88305-26 ?

[cinike]

I have the following situation:

1) My Doctor personally did a shave biopsy on a patient and billed 11102.

2) My Doctor collected the specimen and prepared it for delivery to the lab.

3) The lab sent back a report.

4) My Doctor read the report, evaluated it and discussed it with the patient.

Questions:
A) Can My Doctor bill 87207-26 for reading, evaluating and discussing the report
with the patient in addition to an E/M code (99212)?

B) Should my Doctor bill 88305-26 instead of 87207-26?

C) If 88305-26 is the better code, can 88305-26 be billed and an E/M code (99212)
for the same date of service?

Thanks!

 

[vanessamoldovan]

I have the following situation:

1) My Doctor personally did a shave biopsy on a patient and billed 11102.

2) My Doctor collected the specimen and prepared it for delivery to the lab.

3) The lab sent back a report.

4) My Doctor read the report, evaluated it and discussed it with the patient.

Questions:
A) Can My Doctor bill 87207-26 for reading, evaluating and discussing the report
with the patient in addition to an E/M code (99212)?

B) Should my Doctor bill 88305-26 instead of 87207-26?

C) If 88305-26 is the better code, can 88305-26 be billed and an E/M code (99212)
for the same date of service?

Thanks!

I am unable to advise on the correct lab code without specifically knowing the lab performed. Modifier 26 is to be used when the doctor only does the reading. 99212 can only be billed if there was a face-to-face visit on the date of service.

 

[thomas7331]

88305-26 or 87207-26 would be billed by the provider at the laboratory, usually a pathologist, who evaluated the specimens and wrote the report. You would not bill these for simply reading the report that was received back from the lab. Reviewing lab results, or the interpretations of tests from other providers, and discussing these with the patient is a component of all E&M services, so the provider should incorporate this work into selecting the appropriate level E&M code as per the documentation guidelines for E&M services.