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willnat2

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Our physican office has it's own nuclear lab and echo vascular lab. For example: Our CEO wanted us to split the echo fee into technical component and professional component. The technical component is billed the day the tech does the test. Then when the physician reads the test he bills for the reading fee. The date is the same on both parts, even if the physician doesn't read the test until a couple of days later. That way we aren't billing the pofessional component until it is completed. But now we are getting denials for too many units, and we are having to send in documentation along with an explanation. It isn't for all of tests, just the echos and carotids, and some of those are being paid. Please let me know what we should do.

Thank you,
Leslie
 
I think you are splitting hairs here -- it's the same clinic and you are basically unbundling. You should bill it when the reading is complete. I can't imagine many carriers allowing you to bill two separate charges due to this scenario. Eventually, you're going to be flagged by a carrier and could potentially go on pre-payment review, which would be a nightmare to get off of.
 
willnat2 said:
Our physican office has it's own nuclear lab and echo vascular lab. For example: Our CEO wanted us to split the echo fee into technical component and professional component. The technical component is billed the day the tech does the test. Then when the physician reads the test he bills for the reading fee. The date is the same on both parts, even if the physician doesn't read the test until a couple of days later. That way we aren't billing the pofessional component until it is completed. But now we are getting denials for too many units, and we are having to send in documentation along with an explanation. It isn't for all of tests, just the echos and carotids, and some of those are being paid. Please let me know what we should do.

Thank you,
Leslie
Click to expand...


There was another thread with a similar topic; check the CMS/MAC links we posted there. My understanding of this, is that if a service can be broken into TC/PC components, and the 2 components are performed on different days, then each service should be billed with the appropriate modifier for the DOS that it was actually performed. Can you give more detailed info on the denials you are receiving?...codes used, units, modifiers, dx?

https://www.aapc.com/memberarea/forums/showthread.php?t=118310
 
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