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Pain Management Doctor bill for Interpretation/Read

Kelly Posted Fri 06th of September, 2013 09:46:42 AM

One of the pain management doctors I bill for, has equipment in his office to perform noninvasive vascular testing. CPT codes: 93880-93882 and 93922 - 93924. I wanted to clarify if he could bill for performing the procedure and for the read. Or does the read have to be performed by a radiologist or can a different provider specialty type perform the read, such as a cardiologist?

SuperCoder Answered Fri 06th of September, 2013 12:49:47 PM

If the physician has sufficient training and experience, he may be able to report those codes.

From a CPT perspective, a pain management physician may report a code from any section in the CPT book. But be sure to check the payer policy and state requirements for who may perform the tests. You mention an office, so just as an FYI, note that hospitals can create policies on who provides official interpretations in their facility, too.

As an example of a payer policy, First Coast has a section on Training Requirements in its LCD. It starts off with this:

"The accuracy of non-invasive vascular diagnostic studies depends on the knowledge, skill and experience of the technologist and the physician performing the interpretation of the study. Consequently, the technologist and the physician must maintain proof of training and experience."

"All non-invasive vascular diagnostic studies must be: (1) performed by a qualified physician, or (2) performed under the general supervision of a qualified physician by a technologist who has demonstrated minimum entry level competency by being credentialed in vascular technology, and/or (3) performed in a laboratory accredited in vascular technology."

(Search Document ID L29158 at http://www.cms.gov/medicare-coverage-database/overview-and-quick-search.aspx)

Kelly Posted Fri 06th of September, 2013 15:16:12 PM

Thank you for that information. However, I was asking more-so if a pain management physician can bill for the interpretation and read of the procedure. Meaning can he bill for the professional component as well as the procedure itself. Or does the interpretation of such studies need to be interpreted by a radiologist or per say a cardiologist?

SuperCoder Answered Fri 06th of September, 2013 19:43:26 PM

Hi again. Again, we're talking about looking at any state or payer requirements. For instance, Novitas states, "The accuracy of noninvasive vascular studies depends on the knowledge, skill and experience of the technologist and interpreter. Consequently, the providers of interpretations must be capable of demonstrating documented training and experience and maintain documentation for post-payment audit."

LCD L32754

Kelly Posted Mon 09th of September, 2013 09:58:41 AM

Thank you for all your help! I appreciate the follow-up answer and in such a timely fashion!

Kelly Posted Mon 09th of September, 2013 09:58:49 AM

Thank you for all your help! I appreciate the follow-up answer and in such a timely fashion!

SuperCoder Answered Mon 16th of September, 2013 20:52:52 PM

You are welcome

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