Wiki Jo5359

[jsadrakula]

Jo5359 77003-TC with Pain Procedures

I work with a Pain Practice. I have been auditing there documentation and the codes used.
The Practice owns there Fluoroscopy equipment. Most of the Pain procedures include image guidance. We own the equipment and we are entitled to bill CPT 77003 with a TC modifier. I verified this WPS. They told me the guidelines department said that I was correct but there is no written policy to support the statement that we can bill 77003-TC. Does any one know of any source that would state that 77003-TC can be billed in the office when the practice owns the equipment.

Thank you in advance for your assistance.

 

[aaron.lucas]

Well technically the guidelines for the -TC modifier would be your source. Whoever owns the equipment used to perform a diagnostic test may bill for the technical component unless:

1.) The code is described as being entirely technical. This applies to all modifiers, if the definition of the modifier is in the code description, you dont use the modifier.

2.) Your practice/facility also employs the radiologist or other physician that interpreted and wrote the report. In this case you would bill global instead of splitting it out.

3.) This is a maybe: if you are an ASC, depending on your payor, the flouro may be considered inclusive of your facility fee for the procedure. Here in NJ PIP we modeled our ASC fee schedule after the Medicare groupers, and flouro is one of the things that is included in the facility fee. You would have to check with your individual payor for that info.

Other than these three exceptions if you own equipment then you can bill -TC when it is used. Hope that helps!