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Procedure codes 88321 88323 and 88325

  1. Default Procedure codes 88321 88323 and 88325
    Medical Coding Books
    Can you bill procedure codes 88321 88323 and 88325 with modifer 90 to commericial insurance carriers when the pathologist sends a specimen to an outside lab for consultation and the outside lab is charging you for either of these procedure codes. thank you for your help
    Last edited by RVoorhes; 05-02-2009 at 05:37 AM.

  2. #2
    I've never billed for outside lab services, but my question is why doesn't the other lab bill the patient's insurance? Also 88325 is a rarely used code, did they review the patient's records for this consult or just your original path report? 88325 is a comprehensive consult that entails more than just reading the original report (which isn't comprehensive).

  3. Default billing consults
    i have a question, we do lots of consults and many times we bill back to the referring because either pt has no insurance or we don't participate with it and don't need anymore self pay than we already have , or should anymore bad debt , anyways I just wonder when you bill a consult code,what provider do you bill under???

    also I agree we do tons of consults and I have never used 88325, better have great documentation to be using that one, pathologist must be reviewing more than just past pathology reports.

  4. #4
    We bill under the provider who provided the consultation. Typing this makes me think I must be missing something from the question.

    I don't get directly involved in this apsect but I think that rather than using a HCFA 1500 (CMS 1500?), the billing dept uses a standard invoice with the relevant information, but still use some patient demographics, our provider, and procedure codes...and charges of course. So, I suppose since we are using an invoice, we are billing as the overall facility rather than as the individual provider. That said, there isn't any question which pathologist provided the services.

  5. Default
    I work for a large physician service dept and I was asking because our system only lets us bill for physicians in our system that are linked to that dept, so I would be unable to bill under a provider that didn't work for us.
    I didn't know if anyone billed under providers that were not they own physicians, or if they billed under the requesting physician.

    ( we usually just pay the consult outright if they won't bill under pts insurance, but was wondering if there was a way to bill this to get the money back , or some of it)

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