In CMS
Dec 26th, 2017
Most radiology services or procedures, although described by a single CPT® code, are comprised of two distinct portions: a professional component and a technical component. The professional component is provided by the physician, and may include supervision, interpretation, and a written report. To claim only the professional portion of a service, CPT® Appendix A (“Modifiers”) ...
In Audit
Jul 5th, 2016
Whether you may assign credit in the data review section of medical decision-making (MDM) if the provider separately bills for the professional component of a test is a matter of payer interpretation and policy, as explained by the American College of Emergency Physicians (ACEP): If I bill for an ECG or X-ray interpretation, can I ...
In Billing
Aug 4th, 2015
Occasionally, the total service/procedure described by a single CPT® code is comprised of two distinct portions: a professional component (modifier 26) and a technical component (modifier TC). The professional component of a diagnostic service/procedure is provided by the physician, and may include supervision, interpretation, and a written report. The technical component of a diagnostic service/pr...
Sometimes getting paid for additional work takes ingenuity. Q: In our family practice, I occasionally see documentation stating that one of our physicians removed sutures that were placed by another provider outside the practice, such as an emergency department physician. Should we code separately for the suture removal? A: Both CPT® and the Centers for ...
Aug 1st, 2014
Be sure the medical record carries enough voltage to bypass reimbursement challenges. Physicians often use computer-generated electrocardiogram (ECG) reports as the baseline for their own interpretation and report. Computer-generated ECG reports, alone, do not meet the requirements to code and bill for the professional component of an ECG. The Centers for Medicare & Medicaid Services ...