Neurology & Pain Management Coding Alert

Question: If a physician performs testing such as nerve conduction studies (NCSs) and needle EMGs at a local hospital but provides his own technician, may he report the global code and/or the technical component for these studies, or must we still append modifier -26?

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Answer: If you provide the test in a facility setting, you must append modifier -26 (Professional component), regardless whether the physician owns the equipment, for Medicare payers. By law, the hospital DRG payment covers the technical component of Medicare services for inpatients.
 
Similarly, if the physician's own technician (or the physician himself) performs the test in a facility setting, the physician may claim only the professional component because Medicare rules require that payment for nonphysician services provided to hospital patients be paid only to the hospital. In fact, this requirement applies even if the physician performs the service for a hospital patient in his or her office. For Medicare payers, the only time that you don't use modifier -26 is for outpatients using your own equipment.
 
This rule does not apply to other (private or third-party) payers unless they follow the DRG policy.
 
You may be able to recoup some payment from the facility, however, if the physician provides the equipment and/or technologist or performs the test personally. Although the physician cannot bill the carrier for the technical component under the DRG system, he or she may either bill the facility or establish a separate contract with it to receive the appropriate reimbursement.