State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_90 > GS_90-701

Article 41.

Pathology ServicesBilling.

§ 90‑701.  Billing ofanatomic pathology services.

(a)        It shall beunlawful for any person licensed to practice medicine, podiatry, or dentistryin this State to bill a patient, entity, or person for anatomic pathologyservices in an amount in excess of the amount charged by the clinicallaboratory for performing the service unless the licensed practitionerdiscloses conspicuously on the itemized bill or statement, or in writing by aseparate itemized disclosure statement:

(1)        The amounts chargedby the laboratory for the anatomic pathology service;

(2)        Any other chargethat has been included in the bill; and

(3)        The name of thelicensed practitioner performing or supervising the anatomic pathology service.

The disclosure required underthis subsection shall be printed in a 10‑point or higher font size.

(b)        It shall beunlawful for any hospital licensed in this State to bill a patient, entity, orperson for anatomic pathology services in an amount in excess of the amountcharged by the clinical laboratory for performing the service unless thehospital discloses conspicuously on the itemized bill or statement, or inwriting by a separate itemized disclosure statement:

(1)        The amounts chargedby the laboratory for the professional anatomic pathology services;

(2)        Any other chargethat has been included in the bill; and

(3)        The name of thelicensed practitioner performing or supervising the anatomic pathology service.

The disclosure required underthis subsection shall be printed in a 10‑point or higher font size.

(c)        A bill for anatomicpathology services submitted to a patient, entity, or person for payment shalldisclose the name and address of the laboratory performing the professionalcomponent of the service.

(d)        The requirements ofsubsections (a) and (b) of this section shall not apply to:

(1)        A licensedpractitioner performing or supervising anatomic pathology services, or

(2)        A hospital orphysician group practice where a physician employee or physician under contractto a hospital or a physician group practice is providing or supervisinganatomic pathology services and is compensated by the hospital or physiciangroup practice for the services.

(e)        As used in thissection, the term "anatomic pathology services" means:

(1)        Histopathology orsurgical pathology meaning the gross and microscopic examination and histologicprocessing of organ tissue performed by a physician or under the supervision ofa physician;

(2)        Cytopathologymeaning the examination of cells from fluids, aspirates, washings, brushings,or smears, including the Pap test examination performed by a physician or underthe supervision of a physician;

(3)        Hematology meaningthe microscopic evaluation of bone marrow aspirates and biopsies performed by aphysician or under the supervision of a physician, and peripheral blood smearswhen the attending or treating physician or technologist requests that a bloodsmear be reviewed by a pathologist;

(4)        Subcellularpathology and molecular pathology; and

(5)        Blood‑bankingservices performed by pathologists.

(f)         Nothing in thissection shall be construed to require the disclosure of the terms or conditionsof a contract for the provision of anatomic pathology services between amanaged care organization and a hospital or between a managed care organizationand a physician's practice.

(g)        The requirements ofsubsections (a) and (b) of this section shall not apply to a referringlaboratory providing anatomic pathology services for services performed by thatlaboratory in instances where one or more samples must be sent for a secondmedical opinion on a specimen.

(h)        Nothing in thissection shall be construed as a prohibition on a physician requesting theanatomic pathology services of more than one clinical laboratory for a secondmedical opinion on a specimen.

(i)         Each intentionalfailure to disclose in violation of subsections (a), (b), or (c) of thissection is a separate Class 3 misdemeanor offense punishable by a fine of twohundred fifty dollars ($250.00).

(j)         The respectiveState licensing boards having jurisdiction over practitioners subject to thissection may revoke, suspend, or deny renewal of the license of a practitionerwho violates this section. Each State licensing board having jurisdiction maytake disciplinary action on a finding by the board of intentional violation oran ongoing pattern of violations in the absence of a misdemeanor conviction.

(k)        Not later than sixmonths from the effective date of this section, the respective State licensingboards having jurisdiction, and the Division of Health Service Regulation,shall communicate the requirements of this section to all licensedpractitioners and licensed facilities subject to this section. (2005‑415, ss. 1, 1.1;2007‑182, s. 1.)