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Bravo billing details please

Selina Posted Fri 29th of June, 2018 11:12:07 AM
Hello - Our physicians place the bravo capsule in 2 different scenarios....sometimes at the hospital and we receive the report from the hospital and other times in our physician owned ASC's. Would the 91035 done at the ASC be billed without a modifier and at the hospital with a modifier (since the hospital owns the equipment) ? We are seeking a little more detail than the standard info. Thanks so much!
SuperCoder Answered Mon 02nd of July, 2018 04:47:54 AM

Hi Selina,

Medicare covers 91035 in the ASC setting only as an ancillary service integral to a covered surgical procedure. If performed solely for the purpose of placement of the Bravo capsule it is not a billable service in this setting. For the professional fee if the EGD is completed solely for placement purposes it should not be billed in addition to 91035.

We have an ASC. For the docs, we code 91035 and no modifiers because they purchase the bravo capsule. The capsule is not separately billable because it is inclusive to 91035. It is supposed to be billed on the date of interpretation. Our docs place it after/during an EGD, no code is reported by the ASC for the bravo, only the EGD codes.

If the hospital owns the equipment, the patients comes back to the hospital for downloading and your physician interprets the test, then the place of service would be OH (outpatient hospital) - code 22. Your place of service would be OH with a 26 modifier submitted on 91035 for interpretation only. This applies to all patients–not just Medicare patients. Also see the links below for further clarity and feel free to ask for any further query.

https://www.cghjournal.org/pb/assets/raw/Health Advance/journals/yjcgh/Coding_Corner.pdf 

http://www.cpcmedicalcodingcertificationexamprep.org/cpc-exam-study-guide-for-medical-coder-certification/91035-for-asc-billing

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