Wiki Billing 93306 & 93880 In Office

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maleal25

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Hello just a little confused as how to bill these codes. I work for an Interventional Cardiologist. He contracted a tech to come out and bring the u/s machine to do these procedures in our office. Is there any modifier I should be adding since he doesn't actually own the equipment? Or is sufficient to bill just the codes?

Thanks!
Maria
 
It depends. Is the tech billing as well or is he being reimbursed by the physician directly. If the tech is billing for the technical component, your physician would bill modifier 26 for the professional component. If your office pays the tech directly your physician will want to bill without a modifier. Owning vs not owning is not the issue but the arrangement with the tech.
 
So sorry for the late response, I didn't see your reply. We pay the tech directly for the service. So I guess billing without the 26 or TC is appropriate? The same would apply to stress testing done in office as well?

Thanks so much for the help.
 
maleal25 said:
So sorry for the late response, I didn't see your reply. We pay the tech directly for the service. So I guess billing without the 26 or TC is appropriate? The same would apply to stress testing done in office as well?

Thanks so much for the help.
Click to expand...

In the first example, yes, bill global without modifiers as you are reporting the full service.

Stress test will be different because there is different CPT assigned for doing all components vs each component being billed by different entities.

93015 - All 3 components - Supervision, Tracing & Interpretation and report
93016 - Supervision only
93017 - Tracing Only
93018 - Interpretation and Report only


The Medicare Physician Fee Schedule Look up tool and I think the Medicare RVU file have what is called the PC/TC indicator for each code telling you if you can use a modifier or not:

https://www.cms.gov/Outreach-and-Ed...s/downloads/How_to_MPFS_Booklet_ICN901344.pdf

0 = Physician service codes (no modifiers)
1 = Diagnostic tests or radiology services (Bill TC, 26 or globally depending on what components your office is billing for)
2 = Professional component only codes. (Physician Only component no modifier needed)
3 = Technical component only codes. (Technical only Component, no need for modifier)
4 = Global test only codes (technical and professional together, no need for modifier)

The first example 93306 & 93880 both have a PC/TC indicator of 1.
 
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