I hope these previous responses may help with your question.
Originally Posted by Lisa Curtis
I don't do laboratory coding but was shocked that a pathologist charged me for the professional component of lab tests (80053-26, 80061-26, 84439-26, 84443-26, 85025-26). As far as I am aware these codes cannot be reported with modifier -26. The person at the pathologist office told me that they CAN use mod -26 and charge me the professional fee. Someone please tell me - is this truly appropriate?
You are correct, this is not appropriate. I checked all the labs you indicated above. Here is the last one that I copied & pasted for your review. The same language appeared on the other labs as well. I bolded your answer below. Good luck.
85025 Complete cbc w/auto diff wbc - PC/TC Not Applicable
Description: Complete cbc w/auto diff wbc
PC/TC Indicator: 9: Not Applicable code.Concept of a professional/technical component does not apply.
Last Updated: 01/01/2009
* #6 * * *
02-03-2009, 09:10 AM
Join Date: Apr 2007
Location: Kokomo, IN
modifier 26 on labs
I'm glad it worked in your favor, I agree with you, there should not have been a 26 on any of these codes. The only laboratory codes I have found that require (or are able to use) a 26 are on pathology, histochemistry, histocytopathology. These all require a review by the pathologist therefore, a 26 is appropriate. The codes you mentioned are not normally reviewed by a pathologist and are interpreted by your PCP. (this is my opinion).
* #7 * * *
02-03-2009, 09:33 AM
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