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Billing for Technical Component of Anatomic Pathology - ASC Patients

  1. Default Billing for Technical Component of Anatomic Pathology - ASC Patients
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    We are an independent Anatomic Pathology Laboratory. We are having an issue with being reimbursed for our Ambulatory Surgery Center services (by Medicare) for breast cancer patients.

    In preparation for the surgery, many patients are seen in the hospital's Women's Health Center for ultrasound placement of guide wires. After the placement, the surgery is performed at an Ambulatory Surgery Center (the surgery centers have no business relationship with the hospital).

    Medicare consistently denies claims for the AP technical component because the patient was seen in an outpatient hospital setting and the surgery center on the same date. We are expected to bill the hospital for our technical services.

    We typically bill the technical component with POS 81 and Modifier TC. Is there an additional modifier or explanation we can use to facilitate reimbursement?

  2. #2
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    We are a dermatology practice with an in-house dermatopathology lab. When our providers visit patients in a nursing home and perform a biopsy, we have to bill the nursing home for the technical component. It's the same principle. They do pay us, because all technical services that day are their responsibility.

    So you should be able to bill the hospital. I would suggesting speaking to the hospital's business office and finding out whose attention to send the bill to.

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