Wiki Laboratory Services

[jkb77]

Our family practice clinic draws lab and sends it out to an independent Lab to be performed. For commercial insurance payers we bill the lab CPT code with a 90 modifier we are questioning what the correct place of service would be? Would we use place of service 81-Independent lab or 11-Office?

 

[Walker22]

Our family practice clinic draws lab and sends it out to an independent Lab to be performed. For commercial insurance payers we bill the lab CPT code with a 90 modifier we are questioning what the correct place of service would be? Would we use place of service 81-Independent lab or 11-Office?

The bigger question is why are you billing it at all? Shouldn't the lab be billing for those tests?

 

[jkb77]

The bigger question is why are you billing it at all? Shouldn't the lab be billing for those tests?

The answer to your bigger question is as follows:

CPT has provided a modifier 90-Reference (Outside) Laboratory to be used, "When laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number"

AAPC 2016 Procedural Coding Expert states: "Explanation: Physicians and other providers can collect specimens for lab tests and then send the specimens to an outside lab for testing. They can then bill the patient's insurance for the lab code with modifier 90 appended. Physicians would need to pay the lab separately for the services that they perform, since the lab would not bill the patient's insurance."

 

[Walker22]

The answer to your bigger question is as follows:

CPT has provided a modifier 90-Reference (Outside) Laboratory to be used, "When laboratory procedures are performed by a party other than the treating or reporting physician or other qualified health care professional, the procedure may be identified by adding modifier 90 to the usual procedure number"

AAPC 2016 Procedural Coding Expert states: "Explanation: Physicians and other providers can collect specimens for lab tests and then send the specimens to an outside lab for testing. They can then bill the patient's insurance for the lab code with modifier 90 appended. Physicians would need to pay the lab separately for the services that they perform, since the lab would not bill the patient's insurance."

I meant no disrespect by my phrasing. Reading back, I should have worded that better. My apologies. As to the actual question, I have a better understanding of what you are asking for now. Most labs choose to bill the insurances directly for the services they provide, at least that has been the case for all the labs I have dealt with (dozens, I work for a lab billing consulting service). I did not realize you were paying the lab directly, and that is where my confusion came in. In the circumstance you describe, I would think you would use place of service 11, as that is most likely how your practice is credentialed. Be aware that even though Medicare allows this type of pass-through billing, many insurances do not.

 

[jkb77]

I meant no disrespect by my phrasing. Reading back, I should have worded that better. My apologies. As to the actual question, I have a better understanding of what you are asking for now. Most labs choose to bill the insurances directly for the services they provide, at least that has been the case for all the labs I have dealt with (dozens, I work for a lab billing consulting service). I did not realize you were paying the lab directly, and that is where my confusion came in. In the circumstance you describe, I would think you would use place of service 11, as that is most likely how your practice is credentialed. Be aware that even though Medicare allows this type of pass-through billing, many insurances do not.

No disrespect taken, made me panic for a moment though Thank you so much for your reply back! I appreciate your help. We have been using POS-11 but it was questioned so I just wanted to double check.

 

[Walker22]

No disrespect taken, made me panic for a moment though Thank you so much for your reply back! I appreciate your help. We have been using POS-11 but it was questioned so I just wanted to double check.

Thank you. I wish I could tell you that my answer was definitive, but it's really just a "best guess", since I've never dealt with this situation before. I can see how 81 could be considered correct as well. This is a tough call. Anyone else out there know how to answer this?