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sTAT-HELP!Phyiscian Office Lab vs Independent Lab

  1. #1
    Default sTAT-HELP!Phyiscian Office Lab vs Independent Lab
    Medical Coding Books
    Hello Coders:

    Can some one give me a website to reasearch the billing requirement for a Physician's office and independent lab. If any coders works for a lab company this would really help. It's my understanding Medicare and Medicaid requires all the billing to be performed by one source vs multiple? Any help would be appreciated STAT!

  2. #2
    Indianapolis, IN
    send me an email with questions to and I will try to help.

  3. Default
    Quote Originally Posted by smathis1 View Post
    send me an email with questions to and I will try to help.
    Do you know if an idependent lab can bill 88313/tc without a primary specimen exam code (88300-88309)? The lab only prepares the stain and sends it back to the derms office where he then interprets the stain.

  4. #4
    Indianapolis, IN
    yes, that is billable.
    I have seen labs bill to the physicians, and then the physicians bill globally, but the lab can bill separately if that is what the contract says.

  5. #5
    The outside lab is performing the technical component of the stain, i.e. the cost of materials and the technical expertise to successfully apply the special stain. They are within their rights to seek reimbursement for this technical service. They can bill the referring lab or they can bill a third party payer depending on the legal arrangements that apply.

    The pathologist who interprets the stain bills for the professional component. 88313-TC can be billed by whomever prepared the stain, whether they fixed and cut the original slides, or not. 88313-26 can only be billed by the interpreting physician.

    Surgical Pathology Coding Blog.
    Last edited by whaleheadking; 07-16-2011 at 03:55 PM.

  6. Default
    So the fact that 88313 was designated as an add-on code (before recent CPT descriptor change) does not matter?

    The reason behind this question is we recently received a RAC letter because we billed an add-on code without a primary code.

    If possible please quote source with your response so I can print the information. Thank you!

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