Wiki coding question re: xrays

Create Wiki
M

Mulrich

Guest
Messages
6
Best answers
0
Medicare has started denying xrays billed with a 26 modifier, because pt is considered Inpatient when they are in a rehab facility. The patients are transported to our office for follow up from sx, or other issues, and we have always billed the Professional Component, then sent the Technical Component to the Facility. What we can't seem to get a clear answer on, is this a new policy with Medicare and does it only include when the Patient is in a Rehab facility and not a Nursing Home? We have Skilled Nursing Facilities in our area that are also Rehab Facilities. Will start having to verify if the patient is in the Skilled Nursing area as opposed to the Rehab area? I work for a group of Orthopedic Surgeons...
 
the xrays are being performed in our physicians office. We are using pos 11 (our office)
 
If this is a physician office with your own X-ray then you do not split the X-ray components there is no technical for the facility to bill. However if your provider sends the films to the facility for their radiologist to provide the interp then you should be using the TC modifier. If your provider is performing the interp as well then there is no modifier applied. The problem though is with the POS, if the patient is a registered inpatient then you must use the appropriate inpatient POS so acute care inpatient your POS is 21. This was changed last year.
 
Thank you, this clears it up. Is there a difference if the patient is in SNF, Nursing Home or IRF?
 
one more ?, then I promise to leave you alone, sorry. So we send the whole claim from our office to Medicare? Currently we are splitting the xrays between 26 and TC and sending TC to the Facility to bill. :confused:
 
I cannot see why you would do that unless you are a department of the facility. If you are free standing provider office then you would not do this.
 
You must log in or register to reply here.
Top