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pass through lab billing

Michelle. Posted Mon 23rd of November, 2015 18:20:27 PM

We are a multispecialty clinic, we send our labs to a reference lab and bill commercial insurance companies with a place of service 11 for clinic and modifier 90. Is this correct or should we be billing with place of service of the reference lab?

SuperCoder Answered Tue 24th of November, 2015 03:26:04 AM

Hi Michellle,

The POS designation identifies the location where the laboratory service was provided, except in the case of a Reference Laboratory. A Reference Laboratory must show the place where the sample was taken. If the sample drawn in the Reference Lab, then POS 81 is used or if the sample drawn in a hospital inpatient setting/facility, the appropriate inpatient/facility POS is used. All entities billing for laboratory services should append identifying modifiers (e.g., 90), when appropriate, in accordance with correct coding. For example, a physician billing for a laboratory service provided by a Reference Laboratory would bill with POS 81 and would append modifier 90 to the code.

Michelle. Posted Wed 25th of November, 2015 11:39:48 AM

Thank you for the response. My understanding is that POS 81 is if you are using an independant lab/stand alone lab, which our lab is not. Does that make a difference on the place of service? Are we incorrectly using clinic-11 (which is where the service is provided)?

SuperCoder Answered Thu 26th of November, 2015 02:42:43 AM

Hi,

Yes, you are correct POS 81 is for independent/stand alone labs. If you reference lab is not independent then place of service 11 is correct for this scenario.

Michelle. Posted Tue 08th of December, 2015 19:10:08 PM

We are still struggling with how to proceed with our lab billing. We are merging with another group, they have an independant lab and bill with place of service 81, indicating the performing site on the claim (if sent to another lab, that lab is listed on the claim). Our facility does not use their independant lab, we are currently sending to another reference lab, and billing with place of service 11 listing the clinic wehre the patient was seen as the place of service. If our reference lab has to send the lab on to another performing lab which may be an independant lab, are we required to then use place of service 81 and indicate that performing site or are we still ok using place of service 11 with the clinic location? Or, since we are merging, should we be billing all of ours the same as the facility that we are joining so that all of our claims have the same 81 place of service?

SuperCoder Answered Wed 09th of December, 2015 04:18:15 AM

Hi,

This query is not related to previous query. We will not consider this in followup for previous query, so please post this in a new thread.

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