Wiki Is kidney stone pathology included in ASC fee?

[HReed]

I am new to ASC coding and my facility administrator believes that the performing lab should bill the ASC for the kidney stone pathology as it is a diagnostic test directly related to the surgical procedure. I am not clear as to how this pathology is different from sending skin lesions/lipomas to an outside lab for pathology. Those are billed by the lab to the patient's insurance carrier and is separate from our facility fee.

I would appreciate any feedback or any resource information.

 

[bethh05]

I have never heard of this, is there a contract with the lab or something stating this? The pathologist bills his portion to the insurance also.

 

[HReed]

I have not heard of this either, but my administrator just came from another facility where they had contracts in place with a couple of labs who performed other tests as "preop" tests and the labs billed the ASC, not the patient's insurance. She thinks those contracts included the kidney stones as a "diagnostic/therapeutic" test, which would be included in the facility fee. Cultures and EKGs she knows were in those contracts and those I think are considered "preop" tests so there should be no separate billing. I had that discussion with another ASC when I worked in a doctor's office. They were upset that the dr's office wasn't sending the EKG reports (we were) because it was an additional expense to the ASC to perform the EKG (considered a preop test just prior to performance of surgery so no additional billing).