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84165 Protein Electrophoretic Fractionation

Alyson Posted Wed 21st of May, 2014 10:28:57 AM

Would it be appropriate for a physician owned laboratory to bill for 84165 and then a physician within the group interpret the results, issue a report and bill for the professional component of the 84165 using the 26 modifier?

SuperCoder Answered Thu 22nd of May, 2014 10:14:47 AM

You can bill 84165 with modifier 26 to receive the professional component pay for a physician interpretation ONLY if the ordering physician requests an interpretation. You have to meet these requirements to bill 84165-26
1. The patient's attending physician requests the interpretation.
2. The interpretation is documented by a written narrative report included in the patient's medical record.

3. The interpretation requires the exercise of medical judgment by the pathologist.

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