Question 93306 TC/26 POS 11 w/different physicians

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We have a group cardiology practice and our physicians will interpret tests for each other. If the ordering/treating physician orders a test and a different physician interprets it, would it be appropriate to split bill?

Does it matter which physician is on the claim if the physicians are all under the same tax ID?

Ordering physician: 93306-TC
Reading physician: 93306-26

Ordering physician: 78452-TC, 93015
Reading physician: 78452-26
 
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sls314

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We have a group cardiology practice and our physicians will interpret tests for each other. If the ordering/treating physician orders a test and a different physician interprets it, would it be appropriate to split bill?

Ordering physician: 93306-TC
Reading physician: 93306-26

Ordering physician: 78452-TC, 93015
Reading physician: 78452-26


Who owns the equipment? The TC modifier is to reimburse for the technical charges involved in the use of the equipment, and the 26 modifier is to reimburse for the reading professional's time.

It doesn't matter who ordered the test/procedure. It matters who owns the equipment being used.
 
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Who owns the equipment? The TC modifier is to reimburse for the technical charges involved in the use of the equipment, and the 26 modifier is to reimburse for the reading professional's time.

It doesn't matter who ordered the test/procedure. It matters who owns the equipment being used.
The practice owns the equipment and is in office. Which provider should go on the claim?
 

sls314

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The practice owns the equipment and is in office. Which provider should go on the claim?

I would just bill it globally under the reading physician then.

If the other physician just ordered the test, they don't have anything to bill for. It may be considered part of the MDM when determining the level for the E&M visit.

IMO, they wouldn't bill for the actual test though if they aren't performing or reading it.
 

thomas7331

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We have a group cardiology practice and our physicians will interpret tests for each other. If the ordering/treating physician orders a test and a different physician interprets it, would it be appropriate to split bill?

Does it matter which physician is on the claim if the physicians are all under the same tax ID?

Ordering physician: 93306-TC
Reading physician: 93306-26

Ordering physician: 78452-TC, 93015
Reading physician: 78452-26
It's usual to bill the TC portion under the name of the provider who was on site supervising the procedure, not the ordering provider, but it doesn't matter much because there are no work RVUs associated with the TC and the full payment is going to the practice that owns the equipment, not to the individual provider.

But 93015 is a little different as it is a global procedure which includes 3 components instead of 2: the TC portion, but also the supervision and the interpretation. If the global procedure isn't performed by a single physician, then it needs to be billed with 3 separate codes - 93016 for the supervision, 93017 for the TC and 93018 for the interpretation, with each of the 3 components billed by the responsible physician.
 
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