Wiki ICD-9 Code for mole

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Cheryl Puckett

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Correct Radiology Coding

I am auditing a clinic who bills primarily radiology, however in their office (they own all their own equiptment) they have many specialists who refer from with in.
Ok with that being said, my experience in coding radiology is very limited and although something doesn't "look" right to me I need answers other than just that it seems off?
So here is what is being coded. All of the CPT codes I'm about to list are for the same physician and the place of service is 11.
This is what they are billing.
99214
76700TC
74160TC
72193TC
Q9967
My question is this; is it ok to bill the technical componet with a place of service 11? I have tried to check throughout Trailblazer website to determine this on my own but was unable to find a clearly defined answer.
Or if it's "ok" then please let me know as well. Thank you in advance
Cheryl
 
Radiology

No, that is what I don't get as well. To me they should be billing just the code w/out a modifier. If the referring is under the same group NPI, they own the equiptment, etc?
 
Sue Haydysch

Medicare may require that the TC/PC portion be split into separate claims. Therefore the physician codes with the 26 is on one claim form and the facility billing with the TC codes be on another form.
 
If the doctor (clinic) is reading his own films and owns the equipment, then no modifier (TC/26) is needed.

I work at an ortho office (place of service is 11) we own and read
 
?

If in the fact that they are doing the scan for an outside physician who is billing the read seperately would they still use the same POS, since they are just billing facility charges?
I don't think this is the case but I would like to know all the same?
Thanks
Cheryl
 
You need to be a little more specific has the mole become cancerous?:eek:
 
Radilogy

I work for a group who owns a radiology facility.
They own the facility and the equipment.

We bill globally for all but our Echo's which is ready by a cardiologist.

We contract with a radiologist to read all our reports and bill globally this way.

If we have to send a test out to be read and that radiologist isn't contracted to read for us then we use a TC modifier and the radiologist bills for the PC.
Thanks.
 
If you look up mole in the in the alphabetic list of ICD it refers you to Neoplasm, skin, benign, from there you can check the neoplasm table for the specific site. This may be a case where you will need to query the provider for more information (such as the exact site of the mole, and his suspicions about it). If he feels there are changes you may be able to use Neoplasm, skin (specified site), unspecified behavior. Hope this helps.
 
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