Question GI Pathology Billing Question

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Hi there-
I do billing for a GI group that has a pathology lab in their office, they have a pathologist on staff who runs the lab and does all the readings producing all the pathology reports. Currently the billing process is to bill the pathology under the provider who performed the procedure and took the biopsies not the pathologist on staff. The question the office has asked me to look into is if it is going to be more beneficial to add pathologist to the group and bill directly under her, or is it fine to leave it as it is billing under the provider who performed the procedure? I hope this makes sense and someone can give me a little guidance.

Thank you!
Kristin
 

danachock

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Brainerd, MN
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kchance1241
I have a few questions on this billing practice your facility has. How does your pathologist get reimbursed? The members of all my pathology team(s) get reimbursed by RVUs (billing those professional fees as the rendering provider). Also, simply how does your system kick out the claims without rejections?
Let me provide an example billing from your facility - you have let's say a surgeon billing both the technical and professional fees for a 88305 for a gastric biopsy but they deemed to medical necessity that they also needed to perform an IHC (immunohistochemical stain) for H Pylori billing 88342. Is that charge billed global? If you are billing this charge 88342 both TC and 26 on two separate lines- I am betting some insurance companies are denying it for exceeding the MUE.
Or on those other insurance providers that I truly am crabby at they are paying one charge (the lesser amount) and denying the other claim (with payment included in other service or procedure) and until you review the denial(s); you didn't even know that there was a billing issue.
I am almost sure that there has to be some type of "logic" behind how your facility is billing these charges, but I would sincerely ask those important questions.
Personally, "in your shoes" I would want to bill any pathology professional interpretation charges by the person actually providing them. However, you simply cannot start billing charges for a provider that isn't credentialed to bill from your facility(s). Good luck on finding all your answers.
Please reach out with any additional questions,
Thank you for listening and have a great evening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
Coding Specialist 3 - Pathology, Professional Coding Analyst
 
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