Pulmonology Coding Alert

Question: Our hospital lets outside physicians report 94060 with modifier -26. The hospital, however, still submits 94060, without a modifier. Is this right?

North Carolina Subscriber

Answer: Physicians and hospitals should report the portion of the service they provide.
 
Example: The hospital provides the equipment, facility space and any support staff needed to perform a bronchospasm evaluation. Therefore, the hospital should bill for the technical component of bronchospasm evaluation, assigning 94060-TC (Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator [aerosol or parenteral]; technical component).

When the physician provides the service's professional component, and doesn't work for or receive money from the hospital for providing this service, the physician should report 94060-26 (Bronchospasm evaluation ...; professional component). The professional component for this service includes the interpretation of test results.

If your local Medicare carrier will not accept your claim, you may want to make sure that you and/or the hospital are reporting the correct place of service. Let's say a physician performed the procedure in an outpatient hospital setting. You would use place-of-service code -22 (Outpatient hospital), not place-of-service -11 (Office). 

These place-of-service codes are important because you can't report modifier -TC in a physician office; the physician would either own or lease the equipment. You would report the "global" code in the physician office setting (such as, 94060). Reporting the correct place of service lets you use both -TC and -26.