Neurology & Pain Management Coding Alert

Question: I've always thought that I can bill for both the professional and technical components of electrodiagnostic testing if the neurologist owns the equipment. But, when our neurologist provides testing in a local facility using his own equipment, we don't receive reimbursement for the technical portion of the procedure. What's going on?


New York Subscriber


Answer: In fact, the question of whether the physician can bill for the technical component of electrodiagnostic testing is more complicated than simply, "Does he own the equipment?"

When billing Medicare, for instance, physicians providing services in a hospital or facility setting cannot claim the technical portion of a procedure regardless of whether he owns the equipment.

For instance, if the neurologist performs electromyography and/or nerve conduction studies on a hospital inpatient using his own machine, he must append modifier -26 (Professional component) because the facility receives reimbursement for equipment, etc., under the diagnosis-related group. The hospital DRG, by law, covers the technical component of Medicare services for inpatients.

A physician can still receive reimbursement for inpatient testing. Although the physician cannot bill the carrier for the technical component under the DRG system, he may either bill the facility or establish a separate contract with it to receive the appropriate reimbursement. This would apply in cases when the testing physician:

1. owns the equipment

2. employs the technician who performs the test, or

3. personally performs the test.

Even if the hospital owns the equipment, if either 2 or 3 above is true, the physician can recoup some payment, but this will require negotiation with the facility for which he is providing the tests.