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Billing specimens sent out for special stains

  1. Default Billing specimens sent out for special stains
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    A dematopathologist has recently joined our dermatology practice and I am dealing with some new situations that I am not sure how to code. The dermapathologist is preparing and reading the specimen in-house so we bill a 88304 or 88305 global. Recently he is preparing and reading the slides and then sending them out to path lab to have the specimen prepared with special stains. I know that we need to bill out the technical component with at TC modifier on a separate claim but I am unsure about how we would bill for the professional. The dermapathologist has prepared and read the specimen so can we bill a 88304 or 88305 with no modifier and the special stains 88342, 88312 or 88313 with the 26 modifier? or does the 88305 or 88305 need the 26 modifier too? Or another scenerio is that we bill the 88305 or 88304 twice for the first and second reading???? Please help I cannot get any definite information from anyone. Thanks.

  2. #2
    Default
    Is the outside lab reading and giving you a report on the special stains? Is the outside lab just preparing the stain and your Dr reading them? Is the outside lab billing your office? On your other scenario; NO do not bill twice for the same specimen.

  3. #3
    Default
    A am assuming the outside lab is billing someone else for their services and not you.

    If the outside lab is performing the stains and interpreting them, you don't bill anything for reading thier report.

    If they are performing the stains and and you are providing the interpretation, you bill the stain with a -26 for the professional component. They will bill for the technical.

    You only bill 88304 or 88305 once per specimen, no matter how many times someone looks at it.

  4. Default Special stains
    Quote Originally Posted by tomtom2 View Post
    Is the outside lab reading and giving you a report on the special stains? Is the outside lab just preparing the stain and your Dr reading them? Is the outside lab billing your office? On your other scenario; NO do not bill twice for the same specimen.
    All the outside lab is doing is preparing the special stains. We have a lab in our office that prepares our slides but we are not equiped to do special stains. The doctor in our office and our lab is preparing and reading the original slide and then sending out to an outside lab just to prepare the special stains for a second reading. The lab bills us and we have to bill the insurance for both the TC and the 26. But my problem is that we are not just reading the slides we are also preparing the original speciman. I feel that we should bill a global 88305 with a 88342-26 for we did more that just read. I get the TC part... I am just torn on what to do with the professional. Have you come across this at all?

  5. Default Special Stains
    Quote Originally Posted by whaleheadking View Post
    A am assuming the outside lab is billing someone else for their services and not you.

    If the outside lab is performing the stains and interpreting them, you don't bill anything for reading thier report.

    If they are performing the stains and and you are providing the interpretation, you bill the stain with a -26 for the professional component. They will bill for the technical.

    You only bill 88304 or 88305 once per specimen, no matter how many times someone looks at it.
    All the outside lab is doing is preparing the special stains. We have a lab in our office that prepares our slides but we are not equiped to do special stains. The doctor in our office and our lab is preparing and reading the original slide and then sending out to an outside lab just to prepare the special stains for a second reading. The lab bills us and we have to bill the insurance for both the TC and the 26. But my problem is that we are not just reading the slides we are also preparing the original speciman. I feel that we should bill a global 88305 with a 88342-26 for we did more that just read. I get the TC part... I am just torn on what to do with the professional. Have you come across this at all?

  6. #6
    Default
    If I'm understanding you correctly;the outside lab is only performing the TC and billing you for it. The outside lab does not issue a report or read the slides. Your Dr then reads the slides and reports his findings. If the above is true than you can bill the stain with a 26 modifier.

  7. Default Special Stains
    Thank you...I am going to bill 88305 and 88342-26. I just needed someone else to verify that what I am thinking sounds correct. Your input and time is greatly appreciated.

  8. #8
    Default
    Yes. You bill the biopsy (or whatever) as 88305 and then bill separately for each immunostain you purchased/interpreted 88342.

  9. Default TC Definition
    What constitutes a TC? Is the TC part the actual application of the stain or is it the slide prep?

  10. #10
    Default
    The TC is the successful application of the stain. The slide prep is included in the main bx code.

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