Neurology & Pain Management Coding Alert

Question: We've been receiving denials when our physician completes an EMG in the hospital setting. Our office owns the machine; he takes it to the hospital to do the EMG at the patient's  edside.  Is there to bill the service, or do we need some type of contract with the hospital?

Minnesota Subscriber

Answer: You cannot bill the global procedure if your physician performs the test in the hospital, regardless of who owns the machine. You can only bill for reading the results by appending modifier 26 (Professional component) to the procedure code. The hospital will submit the claim with modifier TC (Technical component).

Option: Consider negotiating a private contract with the  hospital to reimburse your physician for other parts of the service (owning the machine and performing the test).