6. What are the ethical issues surrounding professional component clinical laboratory services?

Billing private patients and private insurance companies for the professional component of clinical pathology services is clearly ethical and appropriate. The American Pathology Foundation and the College of American Pathologists recognize professional component billing. The American Medical Association, since 1993, which develops and publishes all CPT codes has clearly inform the pairs that pathologists may bill for professional components of clinical pathology services using the -26 modifier. In December of 2004 the American Medical Association issued a letter reaffirming that "the use of the -26 modifier is appropriate to describe physician professional services associated with CPT codes 80048-8799 when the physician and only billing for the professional component of the clinical laboratory test (I.E., medical direction, supervision, or interpretation)."

7. What are the legalities involved in billing patients for the professional component of clinical laboratory services?

The legality of billing non--Government payers and private patients is well documented.

In central state v. pathology laboratories of Arkansas the United States court of appeals held that either the payers or the patients are obligated to pay the pathologist charge for the professional component of clinical pathology. The Supreme Court of the United States denied certification in this case, effectively upholding the appeals court ruling in favor of the pathologist.

In a similar case Smith v. Peoria Tazwell ruled that" There is no genuine issue of material fact that the pathologists provide medical services of value to all patients who have laboratory tests performed at hospitals where the pathologists practice. These services include establishing test protocols, performing quality control and assurance, and remaining available to consult with laboratory technicians and treating physicians. The pathologists are entitled to bill patients for the services, regardless of whether the pathologists partially perform the test or review its results.