Radiology Coding Alert

When billing for skilled nursing facility (SNF) patients who present to your radiology practice for x-rays, you should bill the interpretation of the x-ray to Medicare with modifier -26 (Professional component) appended, but the supplier of the technical component must bill the technical component directly to the SNF. The Balanced Budget Act of 1997 requires SNFs to consolidate their billing for Medicare Part A residents, so if your radiologist is still billing global x-ray service for SNF patients directly to Medicare don't expect more than consistent problems. CMS Program Memorandum B-00-67 states, "Medicare carriers will no longer make payment to physicians and suppliers for technical components of physician services furnished to beneficiaries in the course of a Medicare Part A covered stay." Of the more than 11,000 procedures included in Medicare consolidated billing, "any that are considered good old-fashioned basic x-rays including a lot of the nuclear medicine procedures would be billed by the SNF," says Rusti Bauman, RN, BSN, MS, a nurse consultant with FR&R Healthcare Consulting in Deerfield, Ill. Forge a Relationship With the SNF Don't wait until an SNF patient presents for her appointment before you think about how to code the service. When the SNF calls to schedule the x-ray, the receptionist should note the patient's fee ticket to ensure that the coder knows the patient resides in an SNF.

"When the fee ticket gets to the coder, he or she should create another, separate fee ticket," says Deb Hudson, CCS-P, coder at the Mason City Clinic, a 35-physician multispecialty practice in Iowa. "The fee ticket for professional services will go to the patient's Medicare Part B carrier, and the other fee ticket, for technical services, is billed to the SNF with modifier -TC (Technical component)." Hudson suggests setting up separate accounts for the various SNFs in your area so the information is sent to the appropriate party at the nursing facility for reimbursement. She says this process has worked well for her practice, and she reminds coders to include the SNF "OSCAR" number (which identifies the facility) on all claims for SNF patients. Bauman agrees that you should "red-flag" SNF patients right away and reminds coders that you can still bill SNF patients' E/M visits directly to Medicare. Clinical Example Suppose a SNF patient in a covered Part A stay falls and the staff doesn't know what happened to her. After the patient fell, her mobility was fine, but today she is complaining of severe pain in the tailbone and demonstrates a change in level of consciousness. An x-ray of the coccyx would be included in the Part A bill. She presents to the outpatient radiology department of a facility, where the radiology technician x-rays [...]