Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

Billing for interpretation w/o patient

Leslie Posted Fri 06th of April, 2012 20:42:56 PM

Can a physician bill for a radiology service eg. ultrasound 93880 with modifier 26, billing for interpretation service without the presence of the patient.
I think he/she should not since it is not a face-face visit and using modifier 26 means professional component requiring the presence of the patient. I also think that the radiologist can do this but an M.D needs a face-face visit.
Any ideas or links to verify this would be appreciated.
Thanks.

SuperCoder Answered Mon 09th of April, 2012 07:31:28 AM

No, interpretation does not require presence of the patient, but in Emegency case, it requires presence of the patient.
I hope this link could help you:
http://medaphase.net/Newsletter/ViewArticle.asp?ArticleID=32

Leslie Posted Mon 09th of April, 2012 14:51:07 PM

Emergency Departments have different rules but I was asking about an office (outpatient) physician.
When billing, Does the interpretation have to be the date of service the patient had an actual encounter( with the technician)or date of service that the physician/radiologist read the report and interpreted(w/o patient)
eg. 1) 04/01/2012 ultrasound in the office - physician reads ultrasound/interprets on 04/03/2012 but physician bills for DOS 04/01/2012.
2) 04/01/2012 X-Ray with Tech at the hospital - Radiologist reads/interprets on 04/03/2012 but bills for DOS 04/01/2012
ie. when the patient had a face-to-face service
Please clarify on this.
Thanks.

SuperCoder Answered Mon 09th of April, 2012 15:05:32 PM

Hi Leslie,

Thanks for your question again. I have sent your query to our respective auditor, Deborah Marsh, JD, MA, CPC, CHONC and she will guide you soon.

Leslie Posted Mon 09th of April, 2012 18:18:39 PM

Greatly appreciated for your excellent correspondence tactics.
Thanks.

SuperCoder Answered Mon 09th of April, 2012 19:56:01 PM

Hello – A physician may bill the pro fee (mod 26) for interpretation without a face-to-face visit. This doesn’t vary by specialty as far as I know, but it does mean meeting requirements for written reports. Consider the reference to diagnostic test interpretation as a non-face-to-face service in the rules for new or established patient E/M (e.g., “An interpretation of a diagnostic test, reading an x-ray or EKG etc., in the absence of an E/M service or other face-to-face service with the patient does not affect the designation of a new patient” – p. 51, http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf).

Also, Medicare has a (now-delayed) place of service rule change that includes the expectation that the professional component may be performed by a physician/practitioner at a site that is distant from the face-to-face service: “In cases where the face-to-face requirement is obviated such as those when a physician/practitioner provides the professional component (PC)/interpretation of a diagnostic test, from a distant site, the POS code assigned by the physician /practitioner shall be the setting in which the beneficiary received the technical component (TC) service. For example: A beneficiary receives an MRI at an outpatient hospital near his/her home. The hospital submits a claim that would correspond to the TC portion of the MRI. The physician furnishes the PC portion of the beneficiary’s MRI from his/her office location – POS code 22 shall be used on the physician’s claim for the PC to indicate that the beneficiary received the face-to-face portion of the MRI, the TC, at the outpatient hospital.” http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads//R2407CP.pdf; http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7631.pdf

As for date of service, I’ve heard experts recommend using the date of service of the diagnostic procedure as the date of service on the physician’s professional component claim (rather than using the date the physician read the study). As always, if your payer provides a written policy, you should follow that guidance for that payer. At one point, CMS released a transmittal (1823) saying you should use the interpretation date, but that was rescinded.

Leslie Posted Mon 09th of April, 2012 20:53:51 PM

Thank you so much for such a detailed explanation.

Related Topics