Wiki Pathology send outs - Outside consult help

[Kisalyn]

Not getting any hits on the path forum...

Our lab recently sent out a specimen for further testing. This is our first send out and the clinic we sent the specimen to does not do any of their own billing.

The invoice we received included 88342 x 12 units and 88323 consult. This is a Medicare patient and from what I gathered from the Medicare Manual, you would bill with a modifier 90. We included the reference lab CLIA # in the prior auth field, but it came back unprocessed.

Any help would be much appreciated.

 

[bonzaibex]

I don't have any answers on this one, but I am also exploring this topic. What reason did Medicare give for the denial? I'm assuming you got a denial...

Becky, CPC

 

[Kisalyn]

The claim was not accepted and denied. They actually rejected it with a MA130 remark code:

Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.


And CO-4: The procedure code is inconsistent with the modifier used, or a required modifier is missing (04)

I thought modifier 90 was appropriate... I'm definitely missing something, but there's not enough clear information out there that I can find.

 

[gracigoo]

modifier

have you tried putting a mod 59 on either of them, i went into mediregs and it says they are bundled but you can bill with a modifier...