Annette Posted Sun 22nd of January, 2017 14:41:14 PM
Physician is performing and reading the test. I was told to bill 93880 26. It is getting rejected for Payment is adjusted when performed/billed by a provider of this specialty. I called blue cross and then said it can't be billed for the professional end until the facility end does. They wouldn't tell me what that means. Do I bill 93880 for performing the test and then bill 93880 for interpreting it?
SuperCoder Answered Mon 23rd of January, 2017 05:20:01 AM
There are two ways of billing these kind of claims.
1. Facility will bill a global code with no modifier. In this case, provider will get his due from facility for his services (professional component, 26 modifier).
2. Facility will bill with TC modifier for technical component service and provider will bill with 26 modifier for professional service.
Note: Probably, in your scenario, the facility would have billed the global code which is inclusive of both professional and technical component.
Hence, you are advised to get in touch with your facility for reimbursement of service rendered by the provider for professional component.
Annette Posted Tue 24th of January, 2017 17:23:31 PM
I'm sorry. What do you mean by Facility? That is what Blue Cross said but they wouldn't explain. The provider (MD) performed and read the test. It was done in his office.
SuperCoder Answered Wed 25th of January, 2017 05:39:08 AM
Facility is an agency or other site where an activity or process is carried out.
In your scenario: If the equipment by which the test was performed belongs to the provider who did the procedure and interpreted the report; then he/she should bill the global code without any modifier, as it will be inclusive of both professional and technical component.
If your provider took the equipment which belongs to the facility but did the test independently in his office, then the facility will bill for TC (technical component), and your provider will bill for his part of service with 26 modifier (professional component).
Other way round as:
Facility will bill a global code with no modifier. In this case, provider will get his due amount from the facility for his part of services delivered (professional component, 26 modifier).