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76942 Denial by Medicare

Ronald s Posted Thu 04th of October, 2012 00:11:59 AM

Doctor performed a 29848 (Endoscopy, wrist, surgical release transverse carpal ligament). He used 76942 (ultra sound guidance)for the procedure. These were performed at a Hospital. Medicare denied the 76942 - claim not covered by this payer. Must send to the correct payer/contractor.
Can anyone give me some light on this billing?
thank you

SuperCoder Answered Thu 04th of October, 2012 19:05:52 PM

For Hospitals,

Hospital billing – Medicare Part B carriers may not pay for the technical component (TC) of radiology services furnished to hospital patients. Payment for physicians’ radiological services to the hospital is made by the fiscal intermediary (FI) as a provider of service.

Global Billing in an office setting - PC and TC services furnished in a physician’s office, a freestanding imaging or radiation oncology center, or leased hospital radiology department, or other setting that is not part of a hospital are paid by the Medicare Part B carriers under the Medicare Physician’s fee schedule. These services may be billed globally, or by the components.

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PC/26 – The professional component is the interpretation of the results of the test. When the professional component is reported separately the service may be identified by adding modifier 26.

http://www.medicarenhic.com/providers/articles/techprofbilling_0108.pdf

The interpretation of the image/result would be a billable service for the component of the professional service in the scenario you are describing.

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