Wiki Ultrasounds and OVs same day

[EMER_RAE]

Please help me we have been going round and round. My understanding is that we are not allowed to bill:
99213 modifier 25 &
76816 modifier 26

together on the same day. Is this correct? If not where can I find the information on this and scenrios so I can present them to my doctors?

Thanks in advance-
Emily Lloyd, CPC

 

[Lisa Bledsoe]

We own our US equipment so we bill the office visit with modifier -25 and the appropriate US code without a modifier.

 

[EMER_RAE]

Just found out that there is a difference in billing in an office setting and or in a hospital setting. In the office you can bill for both TC and professional. In the hospital depends on your contact and what portion of the reading is done by whom. Is this true???

 

[bonzaibex]

When my OBGYN docs do an ultrasound in the hospital, they always bill out the ultrasound code with a 26 modifier, since they are doing the interpretation and report but do not own the equipment. If done in the office, neither the TC nor 26 modifier is needed because they own the ultrasound equipment, and they do their own reports. If your doc's hospital ultrasounds are being formally reported & billed by another physician, then you may have indeed some sorting out to do. Hope this helps.

Becky, CPC