Wiki Modifier 26 for limited carotid studies 93882?

[ollielooya]

Need help from the wise experienced veterans in this case and hope this forum is the place to post. In the past the specialist has been billing for the limited carotid studies without any modifiers. I'm new to this particular scene and am questioning whether this is appropriate or not. The doctor pays for a monthly service that sends a tech with the doppler machine for the procedures done in his office. Therefore, we cannot charge for the 93882 without appending modifier 26, correct? Doing the necessary research and upon posting this question to another forum have received a reply that caused me to wonder if the tech service performing this procedure is receiving payment from the physician as well as the TC component? Should I be concerned? Is this the normal routine or is it questionable? I'm completely new to this facet of coding, so welcome wise advise and creditable documentation of how we may charge. And I'd like to be able to give this doctor a definitive answer to his concerns about being in compliance without sounding like the novice I am.

Suzanne E. Byrum, CPC

 

[Pam Warren]

You're correct, this code has both the professional and technical component. (A good way to research this it to check out the Physician fee schedule at the CMS website.)

From your post, it appears he does not own the equipment, and is paying for the contracted tech to administer the test, so he's not absorbing the full cost of performing the global code. This means he cannot bill globally. If I'm understanding correctly, he's only doing the supervision, interpretation and report. Bill the code with the -26. The technician and her doppler are going to bill the -TC.

But, I'm not sure what contractual arrangements have been made by this physician, and because he pays for the technician to show up with her doppler, it may be determined that he can bill the global code, since he pays for the use of both the tech and the doppler. What has he arranged? If the doppler company is billing the -TC, it would be unfortunate, because not only is your doc going to get reduced payment for only the professional component, he's absorbing some cost for the technical component, and not getting reimbursed. See if you can take a peek at his arrangement with the doppler company,and re-negotiate for the ability to bill the global code.

If it's determined that you should only bill the -26, you will need to contact your payers to rebill corrected claims.


Hope this helps.

 

[ollielooya]

Pam, that helped A LOT! Thank you. Apparently the tech service does not bill the patient. The provider does the billing for the procedure and pays for the tech's service that is provided, hence charging the global fee. The tech and service do not have the patient's billing info. I'm just a little unsure of the provider's billing procedure in such a scenario, but it appears that it would be acceptable to BILL for the global code? ---Suzanne

 

[eetzler]

CIMT billing clarification

So if an outside vendor is used, can they bill us per procedure, and then we send claims to the payors? And, if we have a specialist perform the technical piece, and the vendor actually processes the scan, can the PCP charge for the professional component if they review the scan and notify the patient of the results