• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten your username or password use our password reminder tool. To start viewing messages, select the forum that you want to visit from the selection below.
  • We're introducing new features and a new look to make the forums easier to use and more valuable to you. See what's new and let us know what you think!

sTAT-HELP!Phyiscian Office Lab vs Independent Lab

brake

Networker
Messages
39
Best answers
0
Hello Coders:

Can some one give me a website to reasearch the billing requirement for a Physician's office and independent lab. If any coders works for a lab company this would really help. It's my understanding Medicare and Medicaid requires all the billing to be performed by one source vs multiple? Any help would be appreciated STAT!
 

slrollings1

Networker
Messages
98
Location
Indianapolis, IN
Best answers
0
yes, that is billable.
I have seen labs bill to the physicians, and then the physicians bill globally, but the lab can bill separately if that is what the contract says.
 
Messages
160
Location
New Orleans, LA
Best answers
0
The outside lab is performing the technical component of the stain, i.e. the cost of materials and the technical expertise to successfully apply the special stain. They are within their rights to seek reimbursement for this technical service. They can bill the referring lab or they can bill a third party payer depending on the legal arrangements that apply.

The pathologist who interprets the stain bills for the professional component. 88313-TC can be billed by whomever prepared the stain, whether they fixed and cut the original slides, or not. 88313-26 can only be billed by the interpreting physician.

WK
Surgical Pathology Coding Blog.
 
Last edited:

sheath

New
Messages
9
Best answers
0
So the fact that 88313 was designated as an add-on code (before recent CPT descriptor change) does not matter?

The reason behind this question is we recently received a RAC letter because we billed an add-on code without a primary code.

If possible please quote source with your response so I can print the information. Thank you!
 
Top