Vijay Posted Mon 30th of July, 2012 21:48:47 PM
We are getting different different denials for CPT 93306, some of the insurance denies this CPT for "AUTH" and some of them as Inclusive,
For some cases we found denied for Professional Component, so we added modifier 26 and re billed the claim. But then the claim gets denied as an inclusive.
Could you please help me in details on CPT 93306 as what needs to be done to get this CPT paid.
SuperCoder Answered Tue 31st of July, 2012 16:46:26 PM
In general, you should be able to report an in-office 93306 (Echocardiography, transthoracic,real-time with image documentation [2D] includes Mmode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography) service without needing to use modifier 26 (Professional component) or TC (Technical component). The global 93306 without these modifiers covers both services.
Caution: If your payer requires you to report each component on the day the provider performs it, you typically will report 93306-TC for the date the provider performs the echo and 93306-26 for the date the cardiologist interprets the data.
Prepare yourself: Be aware that some payers deny the second echo claim when submitted in this manner (separate dates) because they have edits to prevent overutilization of imaging services that dont adjust for billing the two test components separately.
For example, some payers only reimburse one echo in any six month period. If you submit 93306-TC on Monday (the day the team acquires the images) and then submit 93306-26 on Tuesday (the day the doctor interpreted) some payers will deny the 93306-26 based on overutilization.