Question Unbundling question

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Arcata/Redding, CA
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I’m a coder but haven’t worked in a specialist practice before, and I have a question regarding billing related to an in-office procedure.

Someone I know had a 12-core prostate biopsy in his urologist’s office. He got a bill from the pathologist and another one that said “lab pathology general” with the biopsy date. When the number on the 2nd bill was called, the person on the line said the bill was not for the urologist, who would bill separately, but for the facility/staff/equipment/cleaning. The urologist is part of a hosptal-associated specialist group, but they are not located in the hospital proper and records have to be requested from the practice directly and not through the affiliated hospital.

My question is this: Shouldn’t the urologist bill with POS 11, and wouldn’t the associated RVUs for the physician’s office where he schedules regular patient visits compensate for staff/equipment and the like? This seems like unbundling to me, but I don’t feel expert enough to say for sure.

Thanks for weighing in!
 

BLUCIANI

Contributor
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Mount Airy, MD
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Urologist performing the Biopsy procedure:
If the biopsy was performed in the office then POS =11 would be correct for the biopsy procedure

The lab facility:

The lab is a separate entity and would bill for the specimen preparation and handling using POS= 81

The pathologist who views the specimen and determines the diagnosis:
As for the Pathologist billing it's a matter of state law. You can view this information by state using the link below.

 

thomas7331

True Blue
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Yes, for a procedure performed in a private physician office, the urologist would bill POS 11 and there would not be a separate bill for the facility. However, for pathology services there is both a technical and a professional component - the technical component is for the preparation of the slides and the use of the equipment; the professional component is just for the physician's interpretation. If the pathologist was facility-based, then it's possible that the patient would see two separate bills for the pathology, that's in addition to the bill for the urologist's services in the office. The preparation of the slides for the pathologist is not a component of the biopsy procedure and the charges for the use of the urologist's office during the procedure would not normally include this.
 
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