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Wiki -TC Portion Pathology in ASC

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lisner1204

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Location
Dawsonville, GA
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I'm new to both pathology and ASC billing. I have billed our -TC portion of the pathology that was done in our ASC. I billed 88305-TC with a POS of 24. I am being denied with Cigna for inconsistent modifier use and an Aetna denial because "treatment has been rendered by the payer to be invalid or inappropriate place of service". What am I doing wrong? Should I be using POS 11? I can't find an answer. Please help.
 
Wondering if you ever got a response to this or figured it out? We are billing Aetna using POS 11 and getting the "treatment has been rendered by the payer to be invalid or inappropriate place of service" but only on some of our claims. I am completely perplexed.

Thanks!
Christina
 
Hi, I've seen this before. Your facility is billing the TC charge(s). Have you called the facility that is billing out the professional charge(s)? How did they really bill those charge(s) out? Both Aetna and Cigna won't apply the "duplicate claim or service" like BCBS does but they will throw that "inappropriate POS or provider" EOB denial. This is worth a phone call in my opinion.
Thank you for listening and have a great day,
Dana
 
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