Wiki 99211-tc & 81002

[treinemer]

We are having a discussion regarding if you can charge a 99211 TC if a patient drops off a urine sample for 81002.

I would say absolutely not but it is coming into question and I can't find anything official regarding the TC, only the 99211 as a whole. I feel they are one and the same and the only billable charge would be the 81002 unless the nurse roomed the patient and did face to face time.

Which is correct and does anyone have any official reference for this?

Thanks!

 

[mitchellde]

You cannot use TC on a 99211. First the TC is not an E&M modifier and second there is no technical component for an E&M. Unless the nurse has orders in the chart from a previous visit then there is no reason to "room" the patient just to charge a visit level.

 

[treinemer]

You cannot use TC on a 99211. First the TC is not an E&M modifier and second there is no technical component for an E&M. Unless the nurse has orders in the chart from a previous visit then there is no reason to "room" the patient just to charge a visit level.

Sorry, I forgot to add We are a PBB facility and do bill out 26/TC on E/M codes for PBB payors (i.e. Medicare, Tricare, DSHS, etc) but for office visits with face to face time.

My argument is that you cannot bill a 99211-TC alone (no professional charge) with a U/A.

 

[mitchellde]

I have never heard of a PBB facility can you provide a description and why an E&M could be split into a tech and pro component for this place of service? I am curious...
Ok I figured it out I think. Are you referring to provider based clinic in a facility? If so I am still not clear not he use of TC and 26 on the E&M. We never billed our provider based clinics with those modifiers.

 

[treinemer]

I have never heard of a PBB facility can you provide a description and why an E&M could be split into a tech and pro component for this place of service? I am curious...
Ok I figured it out I think. Are you referring to provider based clinic in a facility? If so I am still not clear not he use of TC and 26 on the E&M. We never billed our provider based clinics with those modifiers.

Yes, we are a clinic owned by a hospital So for PBB payors are billed with say a 99214-TC for the facility charge, and a 99213-26 for the professional side (they do not have to match, it depends on criteria). If the patient had other hospital based services done then our TC charges are transferred over to the hospital.

Another example is if a patient is post op, we do the post op code, and a 99213-TC (or what ever level apropriate) for the facility use. Medicare has changed to a single flat rate code now for the facility code so the whole 9921X-TC is one code/one price but the professional side is still billed for non post op visits.

It's extremely confusing and I don't even pretend to understand it....

 

[mitchellde]

Yes I understand the facility will charge an E&M and so does the provider, however we have never used the modifiers, the POS on the the provider side (22) indicates the payer is to pay the reduced rate, and the bill type on 5he facility side does the same. I would be interested in where you read to use these modifiers in this way.

 

[treinemer]

Yes I understand the facility will charge an E&M and so does the provider, however we have never used the modifiers, the POS on the the provider side (22) indicates the payer is to pay the reduced rate, and the bill type on 5he facility side does the same. I would be interested in where you read to use these modifiers in this way.

This was long before I came along when the clinic became PBB. It may just be the way the SIM codes are set up in our system. That is what we see is 99213TC, 9920426, etc

 

[mitchellde]

I see, well you do not use those modifiers with E&M codes even in provider based clinics. The facility bills it charge per their own tool on a UB with rev code 510 and are paid accordingly, the provider bills on the 1500 with POS 22 using the physician E&M guidelines with no modifier and is paid accordingly. Now as far as dropping off the UA, there is nothing for the provider to charge on this. If the facility clinic has this on the tool to be equal to a 99211 then the facility can charge this but it must be on the facility E&M tool. No modifier.