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Is kidney stone pathology included in ASC fee?

  1. #1
    Default Is kidney stone pathology included in ASC fee?
    Medical Coding Books
    I am new to ASC coding and my facility administrator believes that the performing lab should bill the ASC for the kidney stone pathology as it is a diagnostic test directly related to the surgical procedure. I am not clear as to how this pathology is different from sending skin lesions/lipomas to an outside lab for pathology. Those are billed by the lab to the patient's insurance carrier and is separate from our facility fee.

    I would appreciate any feedback or any resource information.

  2. #2
    I have never heard of this, is there a contract with the lab or something stating this? The pathologist bills his portion to the insurance also.

  3. #3
    I have not heard of this either, but my administrator just came from another facility where they had contracts in place with a couple of labs who performed other tests as "preop" tests and the labs billed the ASC, not the patient's insurance. She thinks those contracts included the kidney stones as a "diagnostic/therapeutic" test, which would be included in the facility fee. Cultures and EKGs she knows were in those contracts and those I think are considered "preop" tests so there should be no separate billing. I had that discussion with another ASC when I worked in a doctor's office. They were upset that the dr's office wasn't sending the EKG reports (we were) because it was an additional expense to the ASC to perform the EKG (considered a preop test just prior to performance of surgery so no additional billing).

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