Neurology & Pain Management Coding Alert

Question: Our neurologists sometime perform diagnostic studies on Medicare inpatients in the nearby hospital. My understanding is that if an inpatient is brought to our office for these diagnostic studies, we can  only bill for the professional component rather than the global diagnostic tests. Is this correct?

Oregon Subscriber

Answer: As long as the patient is considered to be an inpatient by Medicare, the technical components (TC) for all diagnostic testing are included in the hospital's payment for the patient's inpatient stay, even those provided in a physician's office site of service. This would also be the case for patients that are covered under a Part A covered stay in a skilled nursing facility. Some commercial payers also take this stance as they likewise reimburse the facility on a diagnosis grouper type arrangement, similar to Medicare.

If your provider is actually performing the technical component and providing the equipment for the diagnostic testing, you can discuss with the hospital for payment for the technical component of the diagnostic tests. Such an arrangement is always better to be agreed upon before the studies are performed rather than after.

If the facility and your physician come to terms of agreement, you will need to know who to send the bill to -- including what address -- as the accounts payable department may not be at the physical address of the facility.

Remember: You will want to find out what format the accounts payable department wants the bill sent. For example, some departments may have no clue what a HCFA 1500 form is or what information it provides. Some will want the information on an invoice type of format rather than the 1500 form.