MARIbilling
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Good Morning All,
Anyone experience denials for billing diagnostic labs codes (Example 84153) by a pathologist?
Anyone experience denials for billing diagnostic labs codes (Example 84153) by a pathologist?
Thank you this is a payer issues, Cigna was not processing the claims correctly, we were submitting correctly, but they were keying claims incorrectly. Thank you for your help.Hello MARIbilling,
I am speculating that this may be a credentialing issue; I have coded pathology for many years. Are you absolutely sure the pathologist really ordered this diagnostic test? That would in my complete opinion absolutely out of the norm in the normal pathology coding realm.
Was something possibly amiss and lost in translation when charges were entered by the accessioner? I would at this point re-review the lab requisition ~ who and validate, who exactly ordered this test and move forward.
I wish you tons of success!
Thank you for listening and have a wonderful evening,
Dana
Hi Thomas, Thank you for your feedback. Cigna is stating its a CMS policy that they are following yet, we own the lab and bill under the pathologist. Medicare reimburses our claims. So, I am thinking it has to do with how they are credentialed in the system. Weird thing is its random, some claims go through and process. It is like 50/50. Tried to look for a trend in codes but its across all services. We are billing globally.I agree, something seems wrong here, a test such as this would normally performed by a clinical laboratory, not by a pathologist, and would have been ordered by another type of specialist. A pathologist might supervise a laboratory, but they wouldn’t personally bill for the diagnostic labs, except in the cases where a particular test may have a professional component that they perform.
Hi Dana,Hello MARIbilling,
I am speculating that this may be a credentialing issue; I have coded pathology for many years. Are you absolutely sure the pathologist really ordered this diagnostic test? That would in my complete opinion absolutely out of the norm in the normal pathology coding realm.
Was something possibly amiss and lost in translation when charges were entered by the accessioner? I would at this point re-review the lab requisition ~ who and validate, who exactly ordered this test and move forward.
I wish you tons of success!
Thank you for listening and have a wonderful evening,
Dana
Also, we are a specialty group with ASC's. These pathologists work for us.Hi Thomas, Thank you for your feedback. Cigna is stating its a CMS policy that they are following yet, we own the lab and bill under the pathologist. Medicare reimburses our claims. So, I am thinking it has to do with how they are credentialed in the system. Weird thing is its random, some claims go through and process. It is like 50/50. Tried to look for a trend in codes but its across all services. We are billing globally.