Editing changes for the TC of pathology services rendered same day as an outpatient hospital visit

Since the activation of common working file (CWF) editing, appeals have increased from physicians and suppliers who have received denials for the technical component (TC) of pathology services when they occurred on the same date of service (DOS) as an outpatient hospital service. While most denials have been upheld, some denials have been overturned based on supporting documentation. Therefore, effective for claims processed on and after January 1, 2014, the CWF will allow the TC of a pathology claim when there is a claim in history from the ordering/referring physician for the same DOS as the TC of the pathology claim and the ordering/referring physician’s claim has a non-hospital place of service, i.e., it is not 21 or 22. The TC of physician pathology services provided to a Medicare beneficiary who is not a hospital inpatient or hospital outpatient (at the time of the ordering/referring physician’s service) is paid on the Medicare physician fee schedule (MPFS).