Arlene Posted Wed 27th of March, 2013 13:24:27 PM
Our MD goes to the hospital and actually performs and reads/interprets EMGs and EEGs for both hospital outpatient and inpatients. The equipment is our equipment, not the hospitals. Can we bill two line items for each component, one with TC and one with 26? The hospital staff does not do any of the work, just the outside practice, we do both the technical and professional portions of each test. We want to be compensated for our time performing the test, which includes hook up, etc. in addition to the professional component because the doc is actually doing every aspect of these tests. Thank you
SuperCoder Answered Mon 01st of April, 2013 22:44:47 PM
Please check the following link http://www.medicarenhic.com/providers/articles/techprofbilling_0108.pdf
Kindly revert if you still needs the clarity.
Arlene Posted Thu 04th of April, 2013 15:20:49 PM
I apologize, I still am not getting it (the purchased test). Medicare will not pay for the test without modifier 26 when the place of service is 21. Our MD actually does the entire test, the hospital tech. does not. How do we get paid for the global test or both portions when the place of service is 21?
SuperCoder Answered Fri 05th of April, 2013 16:09:47 PM
The standard coding guideline when the physician owns the equipment and takes it into the hospital to perform the test and provide the interpretation is to bill the global code. Can you email me the contractor's refusal to pay with POS 21 without modifier 26 or their policy stating so? If you have this in writing, you can email to me at firstname.lastname@example.org. In the mean time (or if my review does not provide further options), you have two option:
Appeal the contractor's denials/policy with an appeals letter providing proof that you own the equipment and bring it to the hospital. The American Hearing Speech Association (ASHA) recommends using the global code when audiologists bring the monitoring equipment to the hospital and provide the monitoring. You can submit the article at http://www.supercoder.com/coding-newsletters/my-otolaryngology-coding-alert/check-nerve-time-equipment-before-reporting-monitoring-combo-article as supporting policy.
The other option is to work with the hospital on creating a payment contract in which the facility reimburses you for the TC portion that they bill.
Jen Godreau, CPC, CPMA, CPEDC