Wiki CPT 47563 and CPT 74300-26

[medicalsec]

This is an old question with varying answers. I have never billed CPT 74300-26 with CPT 47563, however, a new coder insists that it is OK to do this. I can't really find anything officially in writing other than the opinions of people on various sites. Our radiologist at the hospital is usually not in attendance during the procedure, but to meet hospital requirements he dictates a report saying that the procedure was done, but he did not attend. Sometimes he recaps what the surgeon did, but other times he simply states that he was not in attendance but is dictating per hospital requirements .He simply says that the surgeon performed the procedure. The surgeon does not dictate a separate report for CPT 74300. He just states that he did the procedure in the Operative Report.

I had thought that CPT 74300-26 was established just for a radiologist if two people were involved (surgeon and radiologist), but I did not think that it was an additional code that the surgeon could add on with CPT 47563. It is especially confusing since the combination of codes are not listed as bundled. The other coder did state that several carriers pay both codes, but some also do not pay for it. I am hesitate to code it since I am concerned that I will eventually have a request for a large amount of refunds.

I would appreciate any additional resources that could be offered to answer the question.


Thanks,

Deb

 

[lilleyea]

I code for a group of general surgeons and when they perform a laparoscopic cholecystectomy with intraoperative cholangiography we bill 47563 and 74300-26, 52 for reduced services. The radiologist would then bill 74300-26, 52 if they are also not an employee of the hospital. Since the surgeon is doing the supervising and the radiologist is doing the interpretation, they can split the charge and both bill it with a 52 modifier. Here is the resource I used, both the copy and pasted version and the link:

Supervision and Interpretation Codes and Interventional Radiology
Supervision and Interpretation (S&I) Codes and Interventional Radiology

Physician Presence

Radiologic supervision and interpretation (S&I) codes are used to describe the personal supervision of the performance of the radiologic portion of a procedure by one or more physicians and the interpretation of the findings. In order to bill for the supervision aspect of the procedure, the physician must be present during its performance. This kind of personal supervision of the performance of the procedure is a service to an individual beneficiary and differs from the type of general supervision of the radiologic procedures performed in a hospital for which FIs pay the costs as physician services to the hospital. The interpretation of the procedure may be performed later by another physician. In situations in which a cardiologist, for example, bills for the supervision (the “S”) of the S&I code, and a radiologist bills for the interpretation (the “I”) of the code, both physicians should use a “-52” modifier indicating a reduced service, e.g., only one of supervision and/or interpretation. Payment for the fragmented S&I code is no more than if a single physician furnished both aspects of the procedure.

Multiple Procedure Reduction

Carriers make no multiple procedure reductions in the S&I or primary non-radiologic codes in these types of procedures, or in any procedure codes for which the descriptor and RVUs reflect a multiple service reduction. For additional procedure codes that do not reflect such a reduction, carriers apply the multiple procedure reductions.

http://www.radiologybillingcoding.com/2010/10/supervision-and-interpretation-codes.html


Hope this helps!

 

[medicalsec]

Thank you for the reply. What you are saying does make sense. It is the first time that I have heard anyone come up with that example. I appreciate your taking the time to answer.

Deb

 

[lilleyea]

No problem! Happy coding!

 

[tmhgotjss]

S&I Codes for Radiology

In response to your answer and the scenario with CPT codes 47563 and 74300-26/52 , we work for a radiology group and when we try to bill for the radiologist's interpretation, we code 74300-26/52 also. However, our claims often get denied as duplicate claims. Is it acceptable to add a modifier 77 on our claim and rebill? Or is this something that will always need an appeal? Thanks for any response I can get out there from fellow radiology coders!

Radiology Befuddled....