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Radiology HCFA and UB billing

Stephnaie Posted Fri 03rd of January, 2014 10:54:22 AM

Hello, we are a billing service and bill both technical for the hospital and professional for the radilogist. Can you confirm for me how you would bill both if the physician did a 76645 (bilateral breast ultrasound) as well as a consultation with the patient regarding the results of the ultrasound. This was done outpatient in the hospital. Thank you.

SuperCoder Answered Mon 06th of January, 2014 09:33:23 AM

Would like to know if in the vignette above, 76645 was performed by the radiologist or outpatient physician himself performing an Evaluation/Management service on the patient? Also, if the physician and/or performing the procedure is enrolled as an outpatient provider with the hospital and whether both radiology service and counseling were done in the same session/date of service?

Stephnaie Posted Mon 06th of January, 2014 14:10:18 PM

The 76645 was preformed by a hospital technician (not the radilogist). The consult and radilogy service was done on the same session/date of service. The radilogist read the report and did a consult with the patient on the same date of service.

Stephnaie Posted Tue 07th of January, 2014 14:19:19 PM

Can you please respond back. What is the timeline of getting answers on these questions?

SuperCoder Answered Tue 07th of January, 2014 19:16:28 PM

Hi,

We are responding to these. My radiology colleague is working to give you a complete definitive answer.

Thanks,

SuperCoder Answered Wed 08th of January, 2014 04:11:42 AM

With the information gathered from your inputs, the scenario is as following:
Ultrasound, breast(s) (unilateral or bilateral), real time with image documentation - 76645 was performed in an outpatient setting under the radiologist's supervision (actually performed by the technician as is done usually) and the radiologist provided a consult regarding the results with the patient on the same DOS. As a billing service, you would be billing for the technical component on UB-04 and professional component on HCFA. The CPT code for the service would undoubtedly remain the same. For the professional billing, the radiologist's service would be reported as 76645-26. For hospital (technical component of the service) billing, the ultrasound service performed in outpatient department would be reported as 76645-TC. The diagnoses codes justifying the medical necessity of the service should be the same on both the claims.

Stephnaie Posted Wed 08th of January, 2014 09:51:12 AM

I am unfamilier with hospital billing. Do you use CPT codes and modifiers? What about the consult code, where and how is that billed?

SuperCoder Answered Thu 09th of January, 2014 19:43:56 PM

We will let you know soon.

Thanks,

SuperCoder Answered Fri 10th of January, 2014 04:50:18 AM

The consultation provided by radiologist regarding the results is inclusive to the professional service part of the radiological service, so there won't be a separate code for that. The professional component of 76645 billed with modifier 26 is reported for that on professional claim of the radiologist. For the UB-04 billing of this service you might need to refer to the guidelines available from Claims Processing Manual Chapter 25, available on CMS website http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html?DLPage=1&DLSort=0&DLSortDir=ascending
For an outpatient claim on UB-04 you would need to enter both HCPCS code and modifier.

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