tci General Surgery Coding Alert - 2000 Issue 6

Reader Question: Outside Lab Tests

Question: I performed a fine needle aspiration biopsy on a breast mass (88170). Medicare denied payment because our records indicate that you billed diagnostic test(s) subject to price limitations; however, you did not indicate whether the tests were performed by an outside entity or if no purchased tests are included on the claim. (MA110 and CO-16 codes). How should I code this?Connecticut SubscriberAnswer: In some instances, a provider will purchase part of a diagnostic test (the technical or professional component) from an independent entity, and pass these charges on when billing Medicare, says Eric Sandham, CPC, compliance educator...

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