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Pathology Consults

Julia Posted Wed 27th of March, 2013 18:04:06 PM

With the new laws regarding Medicare and Medicaid, on consults the technical component needs to be billed by the facility where the procedure was performed. Our pathologist is on staff at a hospital so the hospital is where the procedure is being performed. The specimen is then sent to us to diagnose. We have a case where our pathologist wanted a second opinion; we sent it out to another pathologist for consult. We are now receiving a bill for the stains that were done by the consulting physician, wanting us to pay for the technical component. So my question is how is everyone handling these cases? Are we to bill the insurance for the technical component then reimburse the consulting physician or is the hospital responsible for billing?

SuperCoder Answered Tue 02nd of April, 2013 05:48:59 AM

This is with our editor. She will respond you soon.


Julia Posted Thu 25th of April, 2013 22:06:26 PM

Still no responce?

SuperCoder Answered Thu 25th of April, 2013 22:14:20 PM


We are sorry. This was skipped from the database. I'll get you the answer soon.


SuperCoder Answered Mon 29th of April, 2013 16:42:36 PM

Answer: As a general rule, providers must bill the technical component (TC) of a “second opinion” pathology consultation and any add-on procedures to the referring hospital if the service date is during an inpatient or outpatient stay. The pathologist cannot bill the TC directly to Medicare.

You don’t specify the procedure, but because you’re asking about TC, presumably the consulting pathologist performs a consultation on referred material and prepares his own slides (88323, Consultation and report on referred material requiring preparation of slides).

In that case, the TC must be billed to the hospital, and the hospital will have a Part B provider number to bill the Medicare Part B contractor for the TC.

Professional component: You’ll need to make sure that the 88323 professional component is billed with modifier 26 (Professional component), because billing 88323 without a modifier indicates that the charge includes the technical and professional components. Unlike TC billing, Medicare rules don’t constrain whether the consultant bills Medicare directly, or makes other billing arrangements with the referring physician or the hospital for the 88323-26 service.

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