Wiki Billing Frozen Sections

[queeniek]

I'm needing some help in billing frozen sections. I'm gonna be as short and clear as possible!

Our group employs several pathologists within the Missouri and Illnois areas. One of our Illinois pathologists travels to a dermatology clinic and performs frozen sections. If a patient has Medicare, do we bill the frozen section to Illinois Medicare? And what place of service? 11? With the derm clinic info in Box 32?

The specimens are then sent to our Missouri office where we process the tissue and then a different pathologist reads the slides. Do those charges get billed to Missouri Medicare? With an 81 POS?

Another scenario we have is that a pathologist does a frozen section in a hospital (sometimes the patient is an outpatient and sometimes they are inpatient), but it was performed at the hospital. What POS should be used on these claims?

Any and all help is appreciated. Thank you!

 

[calexander1265]

Frozen Section

You have several issues so I will address each of them separately. First, when the pathologist goes to the derm office and performs the frozen section you will bill the Medicare in the state where the procedure was performed. So if the derm office is in Illinois, bill Illinois Medicare.
Your second question is pos - if the lab is in derm office bill pos 11 and address in block 32 is the derm office address.

Third - Tissue (I'm assuming, not slides) is then sent to your lab in Missouri. Is the group hospital based or does the group have an independent lab. If the group is hospital based, Medicare rules state the place of service should reflect the location where the procedure was performed. So since the specimen was sent from an office the pos should be 11. If you group is registered with medicare as an independent lab then the correct pos is 81.

4th The pathologist performs a frozen section at the hospital. The correct pos would be the same as what the hospital used for the patient. So if the patient is inpatient you would bill pos 21 and if the patient is outpatient pos - 22.

Hope this helps.