Wiki path consult billing for ref lab - 88342


Omro, WI
Best answers
Our path "consults" are sent to Mayo but, I'm told, they don't do any third party billing. Se will bill ins for their services and then they bill us. Those consults are sent to Mayo only after our pathologists have already examined the specimen and rendered their findings. Thus we have billed for our services too.
Is it appropriate to bill "initial" IHC stains for both entities? The charges would be on separate claims under the appropriate facility name.

Example - if we bill 88342/TC x 1 and 88341/TC x 3, can we then also bill 88342/90 x1 and 88341/90 x 5 (they did a few more stains) with Mayo listed as the ref lab?

I recently noticed that any stains from mayo have been coming across as 88341 only(in addition to the consult code 88323). I questioned the lab (our lab which is who I get the billing from) and they thought that since we already billed 88342 we can't bill another initial. My gut says 88342 should be billed again (especially considering 88341 is an add on code and wouldn't be appropriate to bill without 88342). But we would have to be certain that we use the 90 mod and that Mayo is clearly indicated as the performing ref lab to distinguish that the services were done by different facilities.

second part to the above billing conundrum -
Often times Mayo repeats some of the same stains that were already done by us. Mayo bills us but our lab doesn't feel we should be billing ins or patients for those "duplicate" stains so they are only submit the billing for any additional stains above and beyond what we performed. Is it appropriate for Mayo to be "repeating" those stains and billing for them?

Thank you for your anticipated guidance and direction.