Part B Insider (Multispecialty) Coding Alert

Avoid Denials With The Right HCPCS Portable X-Ray Codes

Published on Mon Jun 27, 2016

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Know how to bill transportation and set-up to ensure your claims are accepted.

For portable healthcare services, transportation and set-up are likely part of the coding scenario. This is particularly true for providers billing portable X-rays, but if you understand the finer points of the Medicare particulars, you’ll avoid audits and denials.

Example: In a recent OIG report, a NY mobile diagnostic service billed for transportation of equipment for one patient, but two patients were actually serviced.

Though the report doesn’t give the specifics, the company likely coded R0070 (Transportation of portable X-ray equipment and personnel to home or nursing home, per trip to facility or location, one patient seen) when they should have used R0075 (Transportation of portable X-ray equipment and personnel to home or nursing home, per trip to facility or location, more than one patient seen) because multiple patients were actually X-rayed.

Of note: It is important to note that the transportation of the equipment is the foundation of this code. “No transportation charge is payable unless the portable X-ray equipment used was actually transported to the location where the X-ray was taken,” says Palmetto GBA, “Medicare will not allow a transportation charge when the X-ray equipment is stored in a nursing home for use as needed.”

Modifiers Matter

With HCPCS code R0075, a modifier must be appended to show how many patients were serviced. There are five U modifiers that go specifically with R0075, and to avoid a returned claim they must be present with your documentation. They are as follows:

UN (Two patients served)
UP (Three patients served)
UQ (Four patients served)
UR (Five patients served)
US (Six or more patients served)

Set-up Alert

Since transportation of equipment to a facility is required to properly bill for portable X-ray services, there is a set-up code that must be included. Q0092 (Set-up portable X-ray equipment) is the HCPCS code you need to input.

Check with your MAC for specific details, but according to Palmetto GBA’s portable X-ray report, the MAC should pay for each X-ray procedure set-up – “other than retakes of the same procedure” – for both individual and multiple patient service.

Resource: For more information about Palmetto GBA’s Railroad Medicare Hub on portable X-ray services, visit http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Railroad-Medicare~8XFHF94345.