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Need help in coding 91010 to Medicare

SuperCoder Posted Thu 14th of April, 2011 16:37:36 PM

Medicare states to use the modifier 26, then denies the claim. Took me over six months for them to pay a claim. The doctor is doing everything at the facility, place of service 22, OP setting. Continue to receive conflicting information, Medicare now stating if the Manometry is performed as pos 22 it is now being bundled global to the hospital, even though billing I'm billing 91010-26 pos 22. Medicare now states interpretation should now bill under pos office 11 with no modifier. More conflicting info, anybody with experience in coding Manometry, 91010 please advise.

SuperCoder Answered Fri 15th of April, 2011 23:35:14 PM

When reporting either 91010 or 91034, you must remember that you cannot get paid for the entire code unless your office owns the equipment. If your gastroenterologist is using another facility’s equipment to perform the manometry, you should attach modifier -26 (Professional component) to the CPT code.

For example, the physicians at your practice have their own equipment set up in an ambulatory surgery center. When they perform esophageal manometries or pH studies in your ASC, then you should report the encounters without any modifiers.
However, when the physicians treat Medicare and Medicaid patients at local hospitals, you should report the encounters with modifier -26 attached to indicate that her practice only deserves payment for the professional service. These payers do not reimburse her practice for the facility fee, she says.
In those instances, the hospital will report the appropriate APC code for Medicare or Medicaid patients or will use the CPT code with modifier -TC (Technical component) for the technical component only.

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