1. Tom Simpkins
   Posted 8 months ago #
   

   If our hospital based pathologist receives a Cyto specimen for another hospital's inpatient. Can we bill the patient's insurance directly for our professional charges? Or do we have to client bill the hospital like our lab does for the TC of the Cyto specimen or clinical lab tests performed on the hospital inpatient?

2. SuperCoder
   Posted 8 months ago #
   

   Whenever your hospital based pathologist receives a Cyto specimen from another hospital inpatient, the billing is based who performed what part of services. Your hospital bills TC of the Cyto specimen on your hospital inpatient, but other hospital inpatients are not inpatients for you when you recieve specimen. So, in this case you can bill PC for your pathologist's interpretation of the slide.
   ***
   TC: Preparation of the slide, involving tissue or cells that a pathologist will interpret.
   PC: Pathologist's interpretation of the slide is the professional component (PC) services.
   Note:-
   The billing is based on who provided what part of the services, ultimately it should not be double billing of the same component.

   ***
   At the same time, this kind of services are provided normally as part of arranged services. When the hospital obtains laboratory tests for outpatients under arrangements with clinical laboratories or other hospital laboratories, only the hospital can bill for the arranged services.

3. Tom Simpkins
   Posted 8 months ago #
   

   These were part of arranged services (through the hospital and not our Dr) for the other hospital's inpatient. So I am correct to bill the patients insurance? Your last paragraph leaves me with doubt that I'm not correct.

4. SuperCoder
   Posted 8 months ago #
   

   Please refer to 4th para of page 18 of the following link:
   https://www.cms.gov/manuals/downloads/clm104c16.pdf

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