Wiki Lab Split billing TC-26

[SebNicole]

Hi All
I am trying to find articles to define Clinical Lab Billing/Coding requirements per Medicare.
We employ the both the Pathologist and the Technician.
Currently the PATHOLIGIST works PART TIME, so we were told we must bill the -26 for pathologist and pay pathologist the exact amount Medicare reimburses for -26.
Pathologist cannot benefit (be compensated) for any of the –TC Medicare reimbursement.
Therefore, we must split bill the -26 and –TC
Does this requirement go away if/when pathologist is employed FULL TIME?

Example: would be a 88305
Technician prepares silds and the Pathologist does the read.
Is it correct to bill to Medicare 88305-26 for part time pathologist read and –TC for Technical component.

 

[kathrynw]

Hi,
I don't think the employment status of a physician, i.e. part time or full time, effects the billing. I think it is determining what the physician actually did. Did he prepare the slide and interpret results or just read the results? AAPC has a great article on 26/TC mods that might be helpful.

https://www.aapc.com/blog/31587-guide-to-modifier-26-and-modifier-tc/

 

[davehudgb]

Hello -

I worked for a pathology provider for about three years. Medicare started to require labs/pathology services split charges into the Technical/26 (Professional) Components, I believe back in the early 2000's. Don't quote me I may be wrong. The reasoning behind this concept is that they were paying potentially the outpatient facility, surgical facility or inpatient hospital the technical component (bundled payment) along with the independent lab/pathology. When the charges are split they are able to have the TC claim deny if the patient has a claim for OP, IP or Surgery Facility - M2 Denial. They will then pay the pathologist the professional component. Employment status of FT vs PT will have no bearing on the processing. This was to eliminate duplicate payments for services performed or should be included in the facility fees. Also we billed for TC/26 by those pathologist that completed both aspects, however, we did split the charges based on Medicare's billing policy. We would receive two payments up to the allowable as if no modifier was indicated on the CPT code. Additionally any Medicare Replacement Policies were filed similar to Medicare, unless otherwise indicated by the carrier.

Hope that helps -