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Modifier 90 on Path codes when the treating physician is also the pathologist

  1. #1
    Default Modifier 90 on Path codes when the treating physician is also the pathologist
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    One of our providers is a board certified dermatologist AND a board certified dermatopathologist. She sees patients as well as reads all the pathology for our clinics.

    We have a Main clinic with a CLIA certified histopathology lab with full Certificate of Compliance and we also have a Satellite clinic with a smaller CLIA certified lab that only has PPMP level of certification.

    When a specimen is obtained at the Satellite clinic and sent back to our Main clinic lab to be read and reported on we attach a modifier 90 to the path code to indicate specimen was sent to an outside reference lab- (our Main location lab).

    One day a week this physician sees patients at the Satellite clinic. When a specimen is obtained on those days, we have a problem billing our path codes (88304 & 88305) for that provider, as the modifier 90 indicates it is inappropriate usage for the treating or reporting physician to complete the laboratory procedure. If we try to submit the path code without a modifier 90, the scrubber will not allow the claim to release saying the code cannot be billed with the CLIA level of certification for that location.... Anyone else run into this? I'm fairly certain this is not the only dermatologist/dermatopathologist clinic in the U.S! Any advice would really be appreciated!

  2. Default
    Quote Originally Posted by kheimerman View Post
    One of our providers is a board certified dermatologist AND a board certified dermatopathologist. She sees patients as well as reads all the pathology for our clinics.

    We have a Main clinic with a CLIA certified histopathology lab with full Certificate of Compliance and we also have a Satellite clinic with a smaller CLIA certified lab that only has PPMP level of certification.

    When a specimen is obtained at the Satellite clinic and sent back to our Main clinic lab to be read and reported on we attach a modifier 90 to the path code to indicate specimen was sent to an outside reference lab- (our Main location lab).

    One day a week this physician sees patients at the Satellite clinic. When a specimen is obtained on those days, we have a problem billing our path codes (88304 & 88305) for that provider, as the modifier 90 indicates it is inappropriate usage for the treating or reporting physician to complete the laboratory procedure. If we try to submit the path code without a modifier 90, the scrubber will not allow the claim to release saying the code cannot be billed with the CLIA level of certification for that location.... Anyone else run into this? I'm fairly certain this is not the only dermatologist/dermatopathologist clinic in the U.S! Any advice would really be appreciated!
    I work with hundreds of dermatology practices across the country that do their own path for services they provide at their own office and satellite offices. None of them need modifier 90. Your claim scrubber is providing you with a false alert.

  3. #3
    Default
    I had come to the same conclusion. THANK YOU FOR VERIFYING! I really appreciate your expertise.

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