Wiki HELP in house lab question TC and 26 modifier

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terridiaz

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I am new to lab billing and need to clear up some confusion.. Here are few of the codes that are done in house.

85025 CBC
80053 CMP
84443 THS
80061 Lipid
86701 HIV

Here is an example of how the physician wants to bill..

85025 26
85025 TC

This would be done for commercial carriers only. I have been trying to research all morning and can't come up with an answer.

Thanks for any help.

Terri
 
Medical Adm

I hope these previous responses may help with your question.

David



Quote:
Originally Posted by Lisa Curtis
I don't do laboratory coding but was shocked that a pathologist charged me for the professional component of lab tests (80053-26, 80061-26, 84439-26, 84443-26, 85025-26). As far as I am aware these codes cannot be reported with modifier -26. The person at the pathologist office told me that they CAN use mod -26 and charge me the professional fee. Someone please tell me - is this truly appropriate?
Thank you!
Lisa,
You are correct, this is not appropriate. I checked all the labs you indicated above. Here is the last one that I copied & pasted for your review. The same language appeared on the other labs as well. I bolded your answer below. Good luck.

85025 Complete cbc w/auto diff wbc - PC/TC Not Applicable
General Information

Code: 85025
Description: Complete cbc w/auto diff wbc
PC/TC Indicator: 9: Not Applicable code.Concept of a professional/technical component does not apply.
Last Updated: 01/01/2009

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* #6 * * *
02-03-2009, 09:10 AM
Anna Weaver
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Join Date: Apr 2007
Location: Kokomo, IN
Posts: 753

modifier 26 on labs
Lisa,
I'm glad it worked in your favor, I agree with you, there should not have been a 26 on any of these codes. The only laboratory codes I have found that require (or are able to use) a 26 are on pathology, histochemistry, histocytopathology. These all require a review by the pathologist therefore, a 26 is appropriate. The codes you mentioned are not normally reviewed by a pathologist and are interpreted by your PCP. (this is my opinion).

* #7 * * *
02-03-2009, 09:33 AM
 
Lab fees?

Hi Terri;

One thing that jumps out at me immediately is the fact that you mention one physician and "in house"; I would not unbundle the coding for a physician doing both parts of the service in his or her office even if the modifiers were permissible. Let me know if you need more clarification on that.

Based on the very limited information we have here, I would not unbundled these lab codes with the Modifiers TC and 26. I am not a lab coder so I checked with my nationally recognized coding program and they say 26 and TC are "n/a".

I hope this helps; thank you.

Susan R., CPC, CPMA, CEMC
 
Someone told me that I could bill both for the same price and would get paid more money by doing it this way, this is how we do our sleep studies. Basically the physician feels he is losing out money by not doing it. So from what I am reading he will get paid less if we bill with a modifier. So we should continue billing with NO modifiers. Can you send me any links where I can find some more information, that way when I speak with them regarding this I can have something to back my information up? Thanks for the responses, I am new to this specialty!
 
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