Wiki PCP & Lab billing same Codes

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uhlerclarem

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Hi all-
We have a provider who did some surgery on a patient and wants to bill 88305, However the outside lab we send the specimen to says we can't do that because we do not have an aggreement with the lab in whcich we would bill globally and pay the Lab their protion. I have tried to explain this to my doctor, but he wants documentation that shows he can't bill this way. HELP!!
 
Is the PCP performing a gross and microscopic exam and rendering a dx on the specimen? Why is he sending it to the lab if he can prepare the blocks and slides and render the dx himself? Is he writing up a report on the specimen including a gross description, etc? Does he really want to be responsible for diagnosing the pathology of the specimen?
 
no he's not-he's just excising it and sending to lab for the diagnosis of the specimen-he is billing for the excision, but he says he can also bill for the same code the Lab will use for the dx of the specimen. I tell him that's incorrect, but his answer is "show me where I can't do this" AAAGH!!
 
I would direct him to the description of surgical pathology in the CPT manual; the first line states "Services 88300 through 88309 include accession, examination, and reporting."

Also, from Carol Buck's text book The Next Step - Advanced Medical Coding "Pathology codes describe the evaluation of specimens to determine the pathology of disease process." (pg. 208 in the 2010 edition).

If your surgeon is not examining the specimen to determine pathology, he/she should not be billing the surgical pathology codes. Now, Mohs surgeons are specially trained to prepare and view their specimens under the microscope, then go back and do more excision as needed. They, then do bill the surgical pathology codes in addition to the Mohs procedures.

Your surgeon is being reimbursed for his/her expertise in removing the specimen, while the pathologist will be reimbursed for his/her expertise in determining the disease process of the specimen.

I hope this helps explain it to your surgeon.
 
Thanks, Debra-
what you said makes total sense!!
Appreciate your feedback and also yours, Lucinda!!
Clare
 
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