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Trish Posted Thu 09th of August, 2012 12:59:57 PM

Can a neurosurgeon bill the fluoro code 76000 for his time during a procedure or is this code only for the radiologist? If the neuro can, what kind of documentation does he need? Does it have to be a separate report or the mention of it in his op report?


SuperCoder Answered Thu 09th of August, 2012 17:47:24 PM

The answer is yes. But there has to be various scenarios to it. Please find it as useful.

Knowing when to bill globally and when to segment a code into the professional component (modifier 26) or the technical component (modifier TC) is crucial in order to properly bill all of the services rendered.

When a service is billed globally, the provider is reimbursed for the equipment, supplies, and technical support, as well as the interpretation of the results and the report.

However, if someone else performed the technical aspects of a service, and the provider only interpreted the results and wrote a report, modifier 26 is necessary to indicate that the provider should receive reimbursement only for the professional component. Similarly, the technical component, modifier TC, includes billing only for the equipment, supplies, technicians, and facility, but not the interpretation of the service.

Strictly following these modifier guidelines is essential to your bottom line, because reimbursement will be higher when a code is billed globally than when it's billed with modifier 26 or TC appended to it. Many specialties have codes that can be billed according to these guidelines, including the following:

Radiology: Most radiology codes, including ultrasounds, x-rays, CT scans, magnetic resonance angiography, and MRIs may be billed with modifier 26 or TC, or with no modifier at all, indicating that the provider performed both the professional and technical services.

For example, a neurosurgeon sees a patient in his or her office . The surgeon requests that x-rays of the patient be taken in his office. The surgeon would bill 76000.

Because no modifiers are appended to the code, the surgeon is indicating to the third-party payer that he or she performed both the technical component and the reading and interpretation of the x-rays for this patient.

If the x-ray were taken elsewhere, such as in a hospital, the hospital would bill the code 76000-TC, indicating that the hospital is billing only for the technical component. The radiologist at the hospital who read the x-ray would also bill the code 76000-26, indicating that he or she read and interpreted the x-ray and wrote a report concerning his or her findings.

Physicians can bill for the professional component of radiology services provided for an individual patient in all settings regardless of the specialty of the physician who performs the service. Reimbursement will be given under the fee schedule for physician services. However, for radiology services provided to hospital patients, insurance carriers reimburse the professional component only under the following conditions:

• Services should meet the fee schedule conditions
• Services provided should be identifiable, direct and discrete diagnostic or therapeutic services given to an individual patient

Written report(s)

A written report, signed by the interpreting physician, should be considered an integral part of a radiologic procedure or interpretation.

The evaluation and management (E/M) documentation guidelines also address the need for a separate written report if the physician is reporting the professional interpretation of X-rays, as follows:

The actual performance and/or interpretation of diagnostic tests/studies ordered during a patient encounter are not included in the levels of E/M services. Physician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The physician’s interpretation of the results of diagnostic tests/studies (i.e., professional component) with preparation of a separate distinctly identifiable signed written report may also be reported separately, using the appropriate CPT code with modifier 26 appended.

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