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Thread: Lab Billing

  1. #1
    Join Date
    Apr 2007

    Default Lab Billing

    AAPC: Back to School
    When billing 88305 is it required to have a diagnosis code attached?

  2. #2
    Join Date
    Apr 2007
    Louisville, KY


    Yes. It is a surgical pathology code--meaning something definitive is required.

    Not to sound stupid, but don't all labs require an ICD for medical necessity?
    Kevin B. Shields, RHIT, CPCO, CCS, CPC, COC, CCS-P, CPC-P, CPC-I

  3. #3
    Join Date
    Apr 2007

    Default Lab Billing

    Thanks for the reponse. We think this is obvisous too, but we are dealing with a provider that feels that an ICD 9 is not required when billing an 88305 technical component only. Can you refer me to where this maybe documented? Thanks

  4. #4


    Section 1842(p)(1)of the Social Security Act requires physicians to report the ICD-9 diagnosis code(s) that explains or justifies the medical necessity of the service or procedure being billed to the Medicare Part B carrier.

  5. #5
    Join Date
    Apr 2007
    Everett, WA

    Default Icd-9

    Are you billing the insurance company or the provider's office/hospital that did the biopsy? If you are billing the insurance company, it is required to have an ICD-9 code. If you are billing the provider, then it is not necessary.
    Shawna Lumpkin, CPC
    Billing Office Manager/Pathology Coder

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