Cardiology Coding Alert

Question: I am billing manager for a group of 22 cardiologists. When we perform a test such as a Thallium or echo in our office, we provide the global service and bill it global. Is it OK to bill under the name of the ordering physician instead of the physician who actually supervises or reads the test? For example, Dr. A sees a patient and orders an echocardiogram. The test is performed in the office and Dr. A supervises the test. However, Dr. B reads the test. Because we bill this global we bill it under the ordering physicians name because we have no idea who is going to read the test. Is this wrong?

Ohio Subscriber

Answer: The answer may vary among payers, but it is generally safe to bill under the ordering physicians name, says C.J. Wolf, MD, CPC, senior coding consultant with Intermountain Health Care, a multispecialty practice in Salt Lake City. The Medicare Carriers Manual (MCM) [14-3-4822.A.2] states, When different physicians in a group practice participate in the care of the patient, the group bills for the entire global package if the physicians reassign benefits to the group. Additionally, in section [14-3-15048.B], the MCM states, If a test is personally performed by a physician or is supervised by a physician, such physician may bill under the normal physician fee schedule rules. This includes situations in which the test is performed or supervised by another physician with whom the billing physician shares a practice.

It is OK to bill the service globally. The only person who might complain is the physician who reads the test, but this is not a billing problem. The way in which physicians work and reimbursement is tracked in a clinic is the responsibility of the facility.

Note: The global service mentioned here does not refer a procedure's global period. Rather, it means that the practice owns the equipment and physicians from the practice provide the interpretation. In other words, billing global means not breaking up components of the test among different physicians, as would be the case if the service were performed at the hospital.