Pathology During Hospital Stay - JE Part B

Common Reasons for Message

• The Global and Technical components of pathology services cannot be separately billed if the patient is under care of a hospital for the date of service.

Next Step

• Verify the Pathology service was billed correctly and includes appropriate modifiers.
  • A reopening can be performed to update appropriate modifiers and place of service
• Patients' inpatient hospital records can be verified using the Noridian Medicare Portal (NMP)
• Patients' outpatient hospital records can be verified with the referring/ordering provider.
  • If the ordering/referring provider received payment with a non-hospital place of service code on the same date of service as the pathology service, and the patient was in an outpatient hospital, the pathology service can be resubmitted.
• Submit an Appeal request - Items or services with this message have appeal rights
  • Submit documentation with Redetermination request. View Medical Documentation Requirements

Claim Submission Tips

• Work with referring/ordering provider to verify the patient’s setting
• Refer to CMS Change Request (CR) 8399 for further details.