Urology Coding Alert

If you think worrying about skilled nursing facility (SNF) patients is something only the billing department needs to do, think again a patient's SNF status determines how you code your urologist's services.

 If a patient is considered an occupant of an SNF bed and you don't know this when you file the claim, you could owe Medicare a refund. CMS is now on the hunt for reimbursement that physicians shouldn't have received under a provision that hit the books last summer. The provision requires you to separately code the technical and professional components of those procedures that have both components.

 According to CMS, for services with both a professional and technical component, Medicare Part B is only responsible for reimbursing the professional component of services provided to SNF patients and refund requests are being issued to practices that have submitted claims for the global payment of services to Part B and erroneously received reimbursement. "They're asking for a refund on the technical component because the patients have Part A coverage through their nursing facility," says Lucia Yang, billing specialist in Williamsville, N.Y.

 Translation for physicians: You'll no longer receive payment from Medicare for any procedures or laboratory studies you perform in the office setting for patients sent to you from a skilled nursing facility bed your reimbursement has to come from the SNF. The program only reimburses physicians for professional services provided to these patients.

 Medicare Part B will reimburse E/M services provided in the office, but various procedures, such as cystoscopies, catheter changes, and Lupron/Zoladex injections, are not payable. So if a urologist performs a service with both a professional and a technical component in his office, he will be reimbursed only for the professional component and only if he codes the service with modifier -26 (Professional component). For the technical component, he must seek compensation from the skilled nursing home.

 When Yang inquired about these refund letters, a Medicare representative explained that medical offices are supposed to bill the SNF for the technical component of the patient visit, and bill Medicare for the professional component, she says. Which means you have to submit separate claims to SNFs and Medicare using modifiers -26 and -TC (Technical component).
Don't Owe Medicare Money

 Here's how it works: To be reimbursed for services that have both a technical and professional component, the provider codes the technical component and submits the claim to the SNF which has received increased funding and payments from Medicare Part A for the total care of the patient for the duration of the patient's occupation of an SNF bed. The SNF is responsible for paying the provider for the services rendered the patient, says Petra Reising, CPC, coding specialist for the Urology [...]