Wiki Who can bill 88342?

[Nola]

The practice I work for has an outside lab that prepares our endo slides. We have a pathologist here that reads the slides and does the reporting. Our billing of 88342 for the immunohistochemical method is billed with a 26 modifier for the professional component. I am understanding that the lab also bills the 88342 with a TC modifier. We have a patient that is questioning their bill so now I am second guessing our process and am having a hard time finding any guidelines. Does anyone have any information they could share?

Thank you-
Nola

 

[danachock]

Billing 88342

Hi Nola,

I also work for a facility that sometimes has to send out specimens to an outside source to have stains applied for interpretation. The send out facility we sent it to would bill out the 88342 with a TC modifier and we will bill the 88342 with 26 modifier because our pathologist on sight performed the interpretation. If you are being denied; I would reach out to make sure that the facility applying the stain (without performing the interpretation) is applying ONLY the TC modifier.
Notice: Sometimes they in error do bill out 88342 as a global fee. (Trust me - my billers have asked me more than once to review this scenario and found that the facility applying the stain was billing a "global" fee).

However if the patient is wondering why both a TC and 26 modifier are being applied to this code for reimbursement. It's because the provider that acquired the specimen is allowed to bill for the application of the stain with the TC modifier and the person (pathologist) that actually provided their professional interpretation to the stain is allowed to bill the professional with the stain code and modifier 26.

Hopefully this sums this up.
Good luck & reach out with any issues.

Thanks,
Dana Chock
Anesthesia, Pathology, Laboratory, & Radiology Coder (CPC, CANPC, CHONC, CPB, CPMA)

 

[Nola]

If the pathologist and the lab are under the same TIN would this be billed the same way or would we bill the global? I would think the billing would be the same.

Thank you-Nola

 

[danachock]

88342

Unsure of your facility's billing practice. If you billed it global 88342 with no modifier you will receive full reimbursement. However if your team is like mine counting on RVU's for the work they performed; then you would bill each 88342 with the appropriate 26 or TC modifier so each provider receives their entitled RVU's.