Laboratory Billing

TCOUSIN

Contributor
Messages
14
Location
Covington, GA
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I am in need of some assistance with laboratory billing. Its been awhile since I've dealt with billing labs and I'm working on an assignment for a physicians office. I was told that in the past labs done in the physicians office was billed to the patients insurance carriew without a modifier. These labs were reimbursed. The office manager states that a consulting company advised them that labs should have been billed with a modifier to show that the rendering provider referred the patient to have labs drawn within the physicians office. The physician owns their own lab. She states that if labs were billed with a modifier that reimbursement would be higher. Is this true and if so, which modifier should be used? Thx for any assistance you can provide.
 

Herbie Lorona

Expert
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417
Location
Yuma, AZ
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I don't believe that is true. From what I know there isn't a modifier you would need to use. Were the codes paid according to your fee schedule?
 

lnbryant

Contributor
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10
Location
Raleigh, NC
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Are these labs being processed at an outside lab? If so, you would need to use modifier 90. In our practice we have certain tests that we bill directly to the patient's insurance and other tests that are more expensive we have the lab bill the insurance. If everything is done and processed in-house (and nothing has to be referred to an outside lab) you do not need a modifier.
 
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