Part B Insider (Multispecialty) Coding Alert

Published on Thu Jul 19, 2007 PDF

Start appealing those denied radiology technical component (TC) claims, officials from the Centers for Medicare & Medicaid Services (CMS) urged.

CMS imposed an edit last April, saying that Medicare wouldn't pay for the TC of radiology services, if they happened on the same date as a patient's hospital admission or discharge.

Example: A provider calling into the Aug. 14 physician Open Door Forum said patients sometimes come into the office and receive X-rays. Then the doctor decides to admit the patient to the hospital the same day. Medicare will deny the TC payment for those X-rays because they-re on the same day as the hospital admission.
The edit which is causing these denials will disappear on Oct. 1, according to Transmittal 1295 (Change Request 5675).

-CMS has determined that some imaging services performed on the admission and discharge dates are being denied,- CMS said in the Transmittal. Medicare should pay for imaging and pathology services on the admission and discharge dates, as long as someone other than the hospital provides them.

So if you-ve received denials based on this edit since April, you should -bring them to the attention of the contractor,- one CMS official advised. -An appeal is one way to do that.-