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How to bill diangostic studies under institute ?

Tsai Posted Tue 18th of June, 2019 17:05:30 PM
Normally I billed MRI of cervical spine w/o contrast with CPT code 72141 with the individual's provider's name in box 31 in CMS 1500 form. My doctor told me I should bill under institute, what is the correct CPT code and if the CMS 1500 claim form is the correct form I should use. Thank you
SuperCoder Answered Wed 19th of June, 2019 04:01:43 AM

Hi Tsai,

 

If you are a doctor and are biling only for your professional services (interpretation of Cervical MRI),  you should bill CPT code 72141 with 26 modifier under your TAX id and Name (in Box 31) in HCFA 1500 claim form. If you are billing CPT code 72141 as a global code (without modifier), it means you are billing for the professional component as well as the technical component. Technical component is billed by the facility that owns the equipment (MRI Machine). That is the reason why you have been advised to bill under institute so that they bill a global code and later provide you the payment for your services (26 modifier - professional services).

 

Hope, provided information would be helpful.

 

Thanks!

 

Tsai Posted Wed 19th of June, 2019 14:53:05 PM
Thank you for your answer. Then should I still use the CMS 1500 from and leave Box 31 -" I Signature of Physician or Supplier Including Degrees or Credentials" should be empty ?
Tsai Posted Wed 19th of June, 2019 15:06:45 PM
I was informed that effective on 06/06/19, the modifier 26 has been changed to PC/26, that is a modifier or two separate modifier "a" --PC, and modifier "b"--26. So confused. Please guide. Thank you.
SuperCoder Answered Thu 20th of June, 2019 02:59:34 AM

Hi Tsai,

 

Please mention the name of the institute in Box 31 and Box 33 in HCFA 1500 form. PC stands for Professional Component and modifier 26 is appended for professional services. Please use modifier 26 for professional services rendered to the patient.

 

Hope, provided information would be helpful.

 

Thanks! 

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