Urology Coding Alert

Question: A patient who is in a skilled nursing facility came to the office for a TRUS, an ultrasonic examination of the prostate, (76872), and a post voiding residual urine (PVRU, 51798). The patient has Pacificare Secure Horizons Medicare replacement insurance. Do I bill all codes at full charge to this insurance carrier or do I bill codes with modifier 26 to the insurance and those with modifier TC to the SNF? Or do the modifier 26 codes go to Medicare Part B and the TC modified codes go to the SNF?Answer: If the skilled nursing facility (SNF) patient has a Medicare replacement insurance plan, in general, you should bill just as you would bill for Medicare, but even before billing check that the patient indeed occupies a skilled nursing bed and check with the particular carrier how they wish you to bill for a SNF patient when seen in [...]