Practice Management Alert

How would you bill each component of this case?

Test your skilled nursing facility (SNF) billing skills with this case study from a Medical Office Billing & Collections Alert subscriber in Maryland.

How would you bill these services? Which would you bill to the Medicare carrier and which would you send to the SNF?

Answer: Your physician can see this patient in your office, and you should bill the E/M portion of the visits as usual. Complications might arise, however, with any diagnostics your physicians run while she's in the office (such as the EKG or spirometry tests). Because she's a skilled nursing facility resident, she falls under guidelines for the Consolidated Billing for Nursing Homes. That means Medicare pays the nursing facility for the technical portion of certain diagnostic tests.

You'll need to bill the following codes: 99214 (Office or other outpatient visit for the evaluation and management of an established patient ...), 93005 (Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report), 93010 (... interpretation and report only), and 94010 (Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement[s], with or without maximal voluntary ventilation).

Step 1: Bill 99214 to Medicare.

Step 2: Then, submit 93010 to Medicare as well. Send the nursing facility a bill for 93005 so they can pay your physician for his service. Although for many codes you would bill the professional component to Medicare using modifier 26 (Professional component) and the technical component to the SNF using modifier TC (Technical component), that method does not apply for ECGs.

Instead, this family of codes provides separate options depending on whether you perform the entire service (93000, ... with interpretation and report), the technical component only (93005), or the professional component only (93010). Therefore, you'll still bill the technical component to the SNF and the professional component to Medicare, but not using modifiers TC and 26.

Step 3: You would handle spirometry tests in a similar way, but include modifiers to distinguish your physician's role. Bill 94010 to Medicare and append modifier 26. Bill the nursing facility with 94010-TC.

Note: Your physician can also see the patient in the nursing facility. If this happens, bill with the nursing home codes (including 99304-99306 for initial care and 99307-99310 for subsequent care) and location (place of service 31, Skilled nursing facility).

Bonus: Want your complicated billing case featured in Bill This!? Send it to editor, Leesa Israel, at leesai@codinginstitute.com.