Pulmonology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer. Question: We send our patients who need fundus photos or fluorescein angiography to the hospital next door. They take the photos and return them to us without interpretation. Is there a way to bill Medicare (and/or private insurance) for the interpretation only? Dr. David Richardson San Gabriel, Calif. Answer: In the Medicare program, payment for testing services that have the term with interpretation and report in their code description in CPT 2000 is allocated separately for the testing procedure and the physicians interpretation. For example, in the Medicare program, code 92235 (fluorescein angiography [includes multiframe imaging] with interpretation and report) includes the test itself as 92235-TC (technical component) and the interpretation as 92235-26 (professional component). If you bill the service without the modifiers -TC or -26, the assumption of the carrier is that both services were provided: 92235-TC + 92235-26 = 92235. If you want to bill for the professional component for the physicians interpretation, you will need to bill 92235-26 and advise the hospital to bill only 92235-TC. This will instruct the carrier to pay the hospital for the test and you for interpretation. Other insurance companies may not recognize the -TC and -26 modifiers. You may want to establish a relationship with the hospital to purchase the tests from them at a set fee with the understanding that they will not bill the patient or insurance company for the service. Then, you can bill the entire service to the insurance company or patient. If you do this, you will need to write yes on the claim form in the area of outside laboratory, yes or no.