Pulmonology Coding Alert

Question: One of our physicians supervised a study at a local hospital, but another physician in our group performed the interpretation of the study. The supervising physician now wants credit for that supervision. It is my understanding that the supervising physician cannot bill the technical component unless he interpreted the study himself. Is this correct?

New York Subscriber

Answer: Studies such as PFTs have a professional portion and a technical portion.

When the physician performs the study in a private setting (e.g., physician office), the physician may report both the technical and professional portion by submitting a claim for the "global" code (e.g., 94060, Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]). When the physician performs services in an outpatient facility setting, the physician reports the professional portion (that is, 94060 with modifier -26, Professional component) and the facility reports the technical portion (that is, 94060 with modifier -TC, Technical component). A physician must provide supervision for the technical portion.

In most cases, there is general supervision (physician available by phone or beeper) or direct supervision (physician available in the office suite) for pulmonary testing.

In some facilities, the facility may report the technical portion by the facility identifying the individual supervising physician's name. The facility reports the professional portion under the interpreting physician's name and bills according to the physician. In independent diagnostic testing facilities (IDTF), the facility reports the global code under the IDTF provider number, assuming the facility has satisfied all of the guidelines required for IDTFs.