Wiki billing ??

[pursley]

Pro Fee
Cardiology services
3 providers with over 17,000 RVUs, high production physicians, and 1 CV surgeon
Cost to charge ratio of 21% for two physicians in card cath. They found that they were writing off a lot for CPT codes 37221 ? 37233. She was told the reasoning was that a non-facility fee schedule and they should be charging the facility rate and adding the -26 modifier. BILLING and regulation issues of concern here.

 

[aclements]

If you look at the CMS fee schedule for codes 37221 and 37233, the status indicator for PC/TC split is "0" which means full service only -26 and -TC are not valid. Hope this helps.

 

[thomas7331]

There is no technical/professional split on these codes, as the poster above points out, but the facility and non-facility rates are very different. Are you physicians performing this procedure in their own office? If not, then their fee schedule maybe be set up incorrectly resulting in a lot of adjustments/write-offs. If the fee was based on the non-facility Medicare RVU but they are doing these procedures in a separate facility, billing a place of service 22 on the claim, then they would be reimbursed the much lower rate. However, if they are doing this in their own office with their own equipment that is not billed with a separate facility/UB claim, then make sure the place of service 11 is correct because if not, it would drive to the lower reimbursement.

Thomas Field, CPC, CEMC