Wiki Bedside Ultrasound

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mbanerjee

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Hi, I work for a Pulmonary group and our doctors are doing bedside ultrasound (76604) using their own equipment inpatient and office and billing 76604 without any modifiers for inpatient and outpatient. However, we are getting denials from insurance companies saying we need preauthorization for these and also for the inpatient ones saying we need to add modifier -26. Can someone please help? Why do we need to use modifier -26 if we are using our own equipment?
Any help will be greatly appreciated. Thank you.
 
Hospitals are responsible for paying for the technical component of all services that are rendered in their facilities because the case rates they are paid are inclusive of these services. If your physicians are using their own equipment, then they would need to bill the hospital for the technical component and only bill the professional component to the patient's insurance. It sounds to me like this is the main issue with your denials if they are asking for the modifier.

In addition, hospitals are responsible for ensuring the safety and quality of any equipment that is used within the facility and it is likely against the hospital's policies for outside equipment to be brought in and used there without their knowledge and oversight. If your physicians wish to continue doing this, they should make the appropriate arrangements with the hospital to get authorization and reimbursement for it, if the hospital agrees to it. Or the hospital may already have their own equipment available for physicians to use for this, in which case there would be no need to be bringing it in.
 
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