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Mid Level Provider Billing

Chris Posted Tue 03rd of September, 2019 16:44:36 PM
When an MD is out of the office, but a mid-level oversees testing for a test such as a stress test (93015) or stress echo(93351), is there an appropriate way to code for the technical component such as using modifier SA and TC while using the MD NPI as the rendering in an outpatient facility or is it more correct to un-bundle and use only the SA modifier. For example, is it appropriate to bill 93015 SA:TC and 93015 26 or is it more appropriate to bill 93016 SA, 93017 SA and 93018 using the MD NPI since SA signifies the MD is billing on behalf of a mid-level.
SuperCoder Answered Wed 04th of September, 2019 07:34:24 AM

Hi,

 

You don't have to attach modifier -26 (Professional component) or  -TC (Technical component) to cardiac stress test codes 93015-93018 because the CPT descriptors break out the components.

 

Use the definitions below to note which codes represent the professional, technical or global components:

CPT 93015 - Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; with physician supervision, with interpretation and report.

This is the global code, which describes the test's technical component, the physician's supervision, interpretation and report. Use this code when the physician performs all of the work and the practice owns the equipment.

 

 93016 - ... physician supervision only, without interpretation and report.

Submit this code only for the physician's supervision, which is a professional service (equipment is not owned by the physician).

 

 93017 - ... tracing only, without interpretation and report.

This code represents the physician's technical service, which means someone other than the physician provided the interpretation, the report and/or the supervision component.

 

 93018 - ... interpretation and report only.

You should use 93018 for the professional services of interpretation and report (equipment is not owned by the physician).

 

If Mid-Level provider does a stress test than report 93017 (Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report) or 93018 (... interpretation and report only), depending on the test performed.

 

Use modifier SA if billing under the supervising physician’s NPI number. The modifier tells the insurer that the NP rather than the physician provided the service and the physician supervised the NP. 

 

Please also check below links for better understanding:

https://www.supercoder.com/coding-newsletters/my-internal-medicine-coding-alert/reader-questions-use-93017-93018-for-stress-tests-under-np-pa-article

https://www.supercoder.com/coding-newsletters/my-cardiology-coding-alert/diagnostic-services-5-steps-will-simplify-how-you-report-stress-echoes-with-stress-tests-154305-article

 

Thanks

Chris Posted Wed 04th of September, 2019 12:02:23 PM
In reading your reply, the first article states that you must bill under the NPP NPI, so that would mean that modifier SA could not be used and could not bill under the supervising MD NPI when billing Medicare, correct? Also, just to clarify, in an office outpatient setting where the equipment is owned by the facility, CPTs 93016, 93017, and 93018 are still eligible codes, right? The main point that I am looking for clarification is if billing under the supervising MD is advisable when they are not in the office and an NP/PA is supervising diagnostic testing in their absence. The NP or PA has the ability to supervise these tests in the MDs absence and lack of presence in the office, but the abiity to use the SA modifier in their absence and billing under the supervising MD seems more ambiguous.
SuperCoder Answered Thu 05th of September, 2019 08:58:00 AM

Hi,

 

You should use HCPCS Level II modifier SA (Nurse practitioner rendering service in collaboration with a physician) for supervised nurse practitioner services when the insurer does require this modifier. Some Medicaid programs such as Medi-Cal require you to apply modifier SA to all nurse practitioner (NP) services which are submitted under the physician provider number. Do not use this modifier for Medicare patients as this modifier is not covered or valid for Medicare and as such reimbursement may be denied.

Modifier SA is used for incident-to services that are billed under the supervising physician’s NPI number. The modifier tells the insurer that the NP rather than the physician provided the service and the physician supervised the NP.

It is not advisable to bill under the supervising MD when they are not in the office and physician did not supervise the NP for the test. So, modifier SA will not be used if physician did not supervise the NP for the test.

If NP or PA has supervised these tests, you must bill these services directly under the NP’s NPI not physician's number. 

 

Please also check below link:

 

https://www.supercoder.com/coding-newsletters/my-evaluation-management-coding-alert/reader-question-check-with-payer-before-adding-sa-138061-article

 

Thanks

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