Wiki Billing Superivision and Interpretation codes

[smerriweather1]

I do the professional billing for a cardiovascular surgeon whose clinic is hospital based. I was given the following codes to bill for a Abdominal Aortic Aneurysm. I am running into a problem when I am attempting to bill out the professional portion 75952 and 75953 CPT codes, because I am being told by our pricing department that they are only priced for the hospital setting and not the professional setting. These codes wording indicate that it includes "radiological supervision and interpretation" which is why I am NOT using modifier 26 (Professional Component). However if my cardiovascular surgeon did the service and is qualified to do the "radiological supervision and interpretation" can he bill for it INSTEAD of the hospital OR should they both bill it? Also of note the radiologist will do an "overread" so I have to make sure that they don't charge for the same services as well. Any suggestions would be greatly appreciated.

 

[tawana76]

I bill for these all the time and my providers perform and interpret the 75962, -26 should be appended, even if done in the hospital. It was must be documented thoroughly of them performing and the interpretation with the results in the operative note. Now if the provider is interpreting ONLY, still -26 modifier.

Rule is for modifier -26 if the equipment is NOT owned by the provider and they are only providing the professional component of the service, use modifier -26.

 

[espressoguy]

To further clarify, yes these codes include the "radiological supervision and interpretation," becuase these are global codes. As the clinic is hospital based, you are not billing the global. The clinic (i.e. hospital) bills for the technical component and the provider bills for the intpretation with the 26 modifier.

 

[smerriweather1]

Thank you.