Peripheral smear billing

[musom]

Question for the group. Talking specifically about PC (85060) billing for peripheral smears. When can I do it? Inpatient only? I've been told that any outpatient can't be billed as it is "included within the medical directorship duties". Let's be specific:

Can I bill outpatients?
Can I bill inpatients if the clinician places an order?
Can I bill inpatients if the tech sees an abnormality and asks me to review the slides?
Can I bill inpatients if the tech sees an abnormality and prompts the clinician to place an order?

What do you do in your practice? Thanks.

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[Torsed]

Who told you that blurb about the "included in medical directorship duties."
It is a charge that medicare even pays so you have every right to bill. My contract says I bill for all professional charges so the excuse about medical director duties doesn't fly. What does your contract say is the big ? I fail to see how clinical work such as peripheral smear review is under the management of medical directors.

Granted it may be a minor matter if you only have a few a weeks and your are raking it in with a large medical director stipend (which I doubt)....we get paid for a limited amount of hours in ours so it doesn't matter.

If I review the PS I bill. I write a comment on the report that is placed into the report what I see (often more elaborate than the silly auto diff or the sleepy tech's comments).

I would estimate I probably have about 40 or 50 a month tops. Its not enough to flag anything and is all documented in the medical record. I do this on inpatient and outpatients.

 

[AZpath]

I believe you can bill if you have an physician order for outpatient. I think the reflex lab reviews can be billed on a inpatient only.

 

[Gene_]

If a physician orders a peripheral smear review and you are generating a report, you can bill it. If you are looking at a peripheral smear because a tech flagged it, that is generally not billable. However, I have worked at a hospital that turns every tech-initiated smear review into a billable 85060 - that practice is very questionable in my opinion.

 

[deleted314957]

If a physician orders a peripheral smear review and you are generating a report, you can bill it. If you are looking at a peripheral smear because a tech flagged it, that is generally not billable. However, I have worked at a hospital that turns every tech-initiated smear review into a billable 85060 - that practice is very questionable in my opinion.

It was my understanding that there had to be a written protocol defining which smears had to be reviewed by pathologist per CMS/CAP. (I had the clinical
Staff review and agree with my parameters). Those cases were reviewed, a written report was generated, and case was billed. Was not a problem a few years ago.

 

[musom]

Who told you that blurb about the "included in medical directorship duties."
It is a charge that medicare even pays so you have every right to bill. My contract says I bill for all professional charges so the excuse about medical director duties doesn't fly. What does your contract say is the big ? I fail to see how clinical work such as peripheral smear review is under the management of medical directors.

Granted it may be a minor matter if you only have a few a weeks and your are raking it in with a large medical director stipend (which I doubt)....we get paid for a limited amount of hours in ours so it doesn't matter.

If I review the PS I bill. I write a comment on the report that is placed into the report what I see (often more elaborate than the silly auto diff or the sleepy tech's comments).

I would estimate I probably have about 40 or 50 a month tops. Its not enough to flag anything and is all documented in the medical record. I do this on inpatient and outpatients.

I am a one-man-show, 52- week medical director for three small hospitals and one multi-specialist clinic. I typically see about two smears a day, so although the 85060 ain't much, it does add up. Also, I'm an employeed physician, so that kinda changes things. My plan is to make all clinicians aware of "suggested criteria for the review of peripheral blood smears" and make sure orders are within the medical chart when they are requested, and yes I'll be billing for them, unless directed otherwise.

 

[Path or bust]

In my experience, all those are billable. Regarding lab tech flags, you can add that as a reflex testing parameters under the medical staff lab reflex testing policy so nobody can say it is "questionable". Anything you review should be added to the medical chart, and billed.

 

[coroner]

Also, I'm an employeed physician...and yes I'll be billing for them, unless directed otherwise.

Well, you failed to mention in the OP that you're employed which completely changes the answer to your question(s). As an employee, services such as PB reviews falls under Part A which is included in your total compensation package. So, that should obviate any reason to bill for any such service separately. The prior statement about "included within the medical directorship duties" should apply in that case. If you send a separate bill for this service to the hospital, they will laugh in your face. And if you plan on billing the patient, that would be illegal as the hospital is already billing them.

 

[Path or bust]

Well, you failed to mention in the OP that you're employed which completely changes the answer to your question(s). As an employee, services such as PB reviews falls under Part A which is included in your total compensation package. So, that should obviate any reason to bill for any such service separately. The prior statement about "included within the medical directorship duties" should apply in that case. If you send a separate bill for this service to the hospital, they will laugh in your face. And if you plan on billing the patient, that would be illegal as the hospital is already billing them.

Interesting take. Whether you are employed or contracted, medical directorship falls under Part A, hospital compensation, which is not a professional service. Although hospitals are supposed to reimburse us, they in many circumstances do not. In fact many hospitals don't directly hire physicians and do it through side companies to avoid laws that prevent them from employing physicians. I don't see why this physician would be treated any differently than a nonemployee for performing a peripheral smear review, which is a professional service under part B that is charged to the patient's insurance, not the hospital.

 

[coroner]

Interesting take. Whether you are employed or contracted, medical directorship falls under Part A, hospital compensation, which is not a professional service. Although hospitals are supposed to reimburse us, they in many circumstances do not. In fact many hospitals don't directly hire physicians and do it through side companies to avoid laws that prevent them from employing physicians. I don't see why this physician would be treated any differently than a nonemployee for performing a peripheral smear review, which is a professional service under part B that is charged to the patient's insurance, not the hospital.

Well, a PB review done because it's flagged by med tech parameters is sort of Part A (medical directorship) as it falls under Q/C but, yes the interpretation/report is Part B. Doesn't matter in this case. An employed pathologist is reimbursed for all services under their contract i.e. medical directorship duties/lab management, clinical laboratory interpretation of tests, anatomic pathology diagnoses, grossing, committee chairmanships, call coverage, etc. Part of the whole idea of being an employed physician is the hospital does the billing for you, so you don't deal with insurance companies and worry about how much revenue is coming in from month to month. You don't see employed pathologists separately billing for doing extra immunos do you? But, that's in their report and requires their interpretation/professional service? Same goes if they do a PB review. It's part of the package deal if one is employed. The patient can legally get billed once and only once for each particular service rendered. Either by the hospital if the pathologist is employed, or directly by the pathologist if they're private.

 

[Path or bust]

Well, a PB review done because it's flagged by med tech parameters is sort of Part A (medical directorship) as it falls under Q/C but, yes the interpretation/report is Part B. Doesn't matter in this case. An employed pathologist is reimbursed for all services under their contract i.e. medical directorship duties/lab management, clinical laboratory interpretation of tests, anatomic pathology diagnoses, grossing, committee chairmanships, call coverage, etc. Part of the whole idea of being an employed physician is the hospital does the billing for you, so you don't deal with insurance companies and worry about how much revenue is coming in from month to month. You don't see employed pathologists separately billing for doing extra immunos do you? But, that's in their report and requires their interpretation/professional service? Same goes if they do a PB review. It's part of the package deal if one is employed. The patient can legally get billed once and only once for each particular service rendered. Either by the hospital if the pathologist is employed, or directly by the pathologist if they're private.

I agree with virtually everything you said.

Since most employed physicians have a large percentage of their reimbursement composed by RVUs, it affects their reimbursement. Most hospitals will want to bill the part A and the part B. Once for the technical component and once for the professional component. I would not equate the PB interpretation of the tech as the only thing that should and can be billed. Both are separate services that are being provided to the patient.