Wiki HELP! audiologist billing question

[liloe517]

We have a Dr that owns the equipment and does the supervision of the testing but then sends the report to an audiologist to interpret. The audiologist doesn't see the patients at all. How would this be billed? The audiologist and Dr are under the same TIN. Thanks for for help.

 

[JenniferB7]

If both the audiologist and physician are billing under the same TIN, then you would report the global service and would not use TC or 26/PC modifiers. This is a great article outlining when you can use TC vs. 26/PC modifiers for reference: http://www.medicalbillingcptmodifiers.com/2011/01/modifier-tc-appropriate-usage-with.html

 

[liloe517]

Thank you for the info. That is what I found also but would the global be billed under the doctor or under the audiologist? I think that it should be billed under the doctor because the audiologist never sees the patient and the doctor supervises the testing.

 

[karen@coastal-ent.com]

Audiology Billing question

Most of our commercial insurances will not credential audiologist and require us to bill under our contracted physician. We have patients that are referred by their PCP and have never seen our physician. Can we bill under our physician if they have never seen him and do not have a plan of care with him?

 

[thomas7331]

I would recommend you talk with these payers or review their policies to find out what their expectations are. In my opinion, any time you are billing a service provided by one individual but putting a different individual's credentials on the claim, and not operating under 'incident to', locum or other established rules, you are potentially putting the practice at risk, so I would not do this without clear and written guidance from the payer. If a payer offers audiology benefits to their members, they must have a process in place for how providers are supposed to credential and submit the charges appropriately. You may want to contact the payer network services or your office's network rep about this - telephone call-center representatives may not have the level of knowledge to get you to the information you need.

 

[Stacey Walden]

Non-commercially contracted audiologist - Texas practice

Hello,

We have recently brought on a new audiologist to our Texas practice who is NOT commercially contracted but is contracted with Medicare. Typically when she is seeing a patient for hearing test the patient also sees one of our doctors. We have been advised that it is appropriate to bill under the physician's NPI in this instance. However, on the rare occasion that she is the only provider seeing the patient and they have a commercial plan how should this be billed (especially if the patient is new and has not established with one of our physicians).

Any help is appreciated!