Wiki Laboratory/Pathology using TC modifier

[kmetz]

Codes 88300 - 88309.
Dermatologist -- When billing these codes the dermatologist is qualified to read certain pathology, he then bills a global fee. When he is not qualified or has concerns with a specimen, he then sends the code to a Pathologist to read, and bills the code with a TC modifier. Is this correct? Does he need to use the TC modifier?

 

[msrd_081002]

TC component/path

Codes 88300 - 88309.
Dermatologist -- When billing these codes the dermatologist is qualified to read certain pathology, he then bills a global fee. When he is not qualified or has concerns with a specimen, he then sends the code to a Pathologist to read, and bills the code with a TC modifier. Is this correct? Does he need to use the TC modifier?

-------------------------------------------------------------------------------------
Can you please be more specific in your query?
1. Did the dermatologist prepared slide, interpreted slide, and prepared report?
2. Is it sent to an independent lab?


Pathology CPT codes 88300 - 88309 include the accession, examination and report. Therefore, if only a portion of the code is performed, the appropriate modifier must be used.

Example 1: Dermatologist prepares slide, interprets slide, and prepares report – code 88300 or 88309. The global service has been performed by the dermatologist.

Example 2: The tissue is sent to an independent laboratory for slide preparation. The slide is read by the dermatologist who then prepares the report. In this instance the laboratory does the technical component and the dermatologist performs the professional component. Modifier –TC is appended to the code indicating the technical component and modifier –26 indicates the professional component. The proper coding would be: 88304 –26 and 88304 –TC; or 88305 –26 and 88305 –TC.
Note, billing the technical component to Medicare must be the exact charge the laboratory charges for the slide preparation.

Example 3: The tissue is sent to the laboratory for slide preparation, interpretation and report. The report is received by the dermatologist. The dermatologist reports the global service, indicating that this service was done by an outside laboratory by code 88304 –90 or 88305 –90. The outside laboratory information would need to be reported on the claim form. This billing is appropriate only for non-Medicare claims.
Managed care organizations may have specific rules regarding billing for pathology global service.