Wiki Global billing for specimen sent for consult

[Whitney]

Hello,

We have pathology lab in our clinic and bill globally for our pathology services. However, when our dermatopathologist sends out a specimen to another laboratory for an expert opinion, we have been billing the pathology codes for these specimens with the technical component only. It has come to our attention that we should actually be billing for the global service, as the physician did also perform the professional component prior to sending off for an expert opinion. The consult lab is actually billing 88321 or 88323, not our pathology code with the 26 modifier.

Does anyone have information on this scenario, or has the same scenario in their practice on how to properly bill?

Thank you so much for your advice.

 

[danskangel313]

What codes are you billing?

Here's an example I just helped someone with:
A provider takes two separate samples, prepares the slides and interprets them. The provider decides an outside opinion is necessary so the biller codes 88305, 88305-TC, assuming the consulting provider would bill 88305-26 (even though the original provider DID actually prep and interpret the second slide as well as the first).

When a specimen is sent for a consult, the billing works a bit differently. You'd code for the services that were performed at your facility; in the example it was 88305 x 2. I suggested the coding might have to be 88305, 88305-59.

The consulting provider would bill a consultation code ONLY based on what work the consulting provider did.
88321 Consultation and report on referred slides prepared elsewhere (this would be the case in the example)
88323 Consultation and report on referred material requiring preparation of slides (this would be if the consulting provider had to prepare the slide)
88325 Consultation, comprehensive, with review of records and specimens, with report on referred material (this would happen if you sent the specimen AND the complete medical record)

Their coding is correct.

 

[Beeper1106]

what codes are you billing?

Here's an example i just helped someone with:
A provider takes two separate samples, prepares the slides and interprets them. The provider decides an outside opinion is necessary so the biller codes 88305, 88305-tc, assuming the consulting provider would bill 88305-26 (even though the original provider did actually prep and interpret the second slide as well as the first).

When a specimen is sent for a consult, the billing works a bit differently. You'd code for the services that were performed at your facility; in the example it was 88305 x 2. I suggested the coding might have to be 88305, 88305-59.

The consulting provider would bill a consultation code only based on what work the consulting provider did.
88321 consultation and report on referred slides prepared elsewhere (this would be the case in the example)
88323 consultation and report on referred material requiring preparation of slides (this would be if the consulting provider had to prepare the slide)
88325 consultation, comprehensive, with review of records and specimens, with report on referred material (this would happen if you sent the specimen and the complete medical record)

their coding is correct.

question how would you bill if you were the consulting provider if there was more than one sample?

 

[ellzeycoding]

You bill for your services globally, if you both made and read the slides in-house.

On occasion, a dermpath may request an expert opinion and send the already prepared slide out for a "second opinion" or additional "consultation". You are still eligibile to bill for your services globally.

The provider that performs that service would bill the 88321 or 88323 themselves under their own NPI number.