Wiki 93351 and 93352 - another question

[richheller]

is the following correct? if so, is there any published documentation verifying that these cannot be used in the facility setting? thanks in advance for any assistance anyone can provide.

-93352 cannot be reported by the physician in a facility-based location. It represents the administration of contrast and does not include the charge for the contrast itself. It can only be reported in the office setting (where contrast stress echos may not be typically performed).

-Without contrast, the physicians would report the stress echo as 93351 (a single code) when performed in the office. When performed in hospital-based locations, physicians report the stress echo w/o contrast as 93350-26, 93016 and 93018 while the hospital reports 93550-TC and 93017.

rich heller, cpc

 

[dbennerman]

in a hospital out-patient setting can you bill the 93351?

 

[Lisa Schwaesdall]

93351

I wish we had some clarification re: use in a facility setting on this from a coding consultant...but...I can tell you w/confidence that CMS has assigned a PC/TC Indicator of "4" to 93351 which identifies it as a "stand-alone code that includes values for phys work, practice expense, and malpractice expense. This tells me that if the facility is billing for all the components the physician cannot bill separately for his/her part. Usually, global codes are for use in a non-facility/clinic setting where all expenses are shared by one group and are billed together.
I don't understand why the 93352 cannot be billed by the physician in the facility setting when the facility is billing for the contrast agent. It would also be nice to have more clarification re: this as well.