Neurology & Pain Management Coding Alert

Question: A neurologist performs a nerve conduction study on a patient in the hospital as an outpatient. He conducts the test using the hospitals space and equipment, so the procedure is billed with modifier -26 (professional component). According to Medicare, the professional fee is calculated at 30 percent of the 1995 RVU and the technical fee is calculated at 70 percent. Is there a way to get this changed?

Montana Subscriber

Answer: Unfortunately, if you perform the tests in the hospitals space, you cannot get around the hospital billing the technical fee and the neurologist billing the professional fee. This is the correct way to bill. The technical- component payment of the nerve conduction study includes the technician placing the electrodes (which is what your neurologist is doing), so you should contract with the facility and have them pay you back a portion of the technical-component fee that they receive.