Wiki Billing For SNF Patient Seen In Office Setting

[A51080]

A Medicare patient who is currently in a SNF has an office visit with an Orthopedic Surgeon. Xrays of the patients knee are performed/interpreted at the visit by the Orthopedic Surgeon. Would you bill the E/M to Medicare, and the xray (with the appropriate RT/LT modifier NOT a TC/26 (since the provider performed/interpreted the xray)) to the SNF?

 

[SharonCollachi]

Physicians professional services are separately billable: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2793739/

I cannot recall if they are separately billable in office POS (I think they are).

 

[mjlan_72@yahoo.com]

We usually split out xrays to SNF with TC mod and send E/M to Medicare. We just have a heck of a time getting the SNF's to pay.

 

[A51080]

We usually split out xrays to SNF with TC mod and send E/M to Medicare. We just have a heck of a time getting the SNF's to pay.

That has been my experience as well, it is difficult at best to get reimbursement from the SNF. I posed the question because a co-worker who just recently started working ortho A/R had suggested billing the xray to Medicare with modifier 26 and the SNF with modifier TC. However as a coder that didn't make sense to me, using 26 & TC. I have always just billed it to the SNF the same as I would bill it to Medicare. It sounds like no matter what modifier you use on the xray SNF will take their time to pay if they pay at all. Thank you so much for your feedback!

 

[mjlan_72@yahoo.com]

Yes, that is correct. You could split it out -26 portion to Medicare and -TC portion to SNF. Unfortunately, if we miss splitting it out and find out we should have sent to the SNF, it is too late to bill to Medicare; from our experience. I work with a company that works a clinics AR. A lot of them were not properly billed out. Since we took over, we have split it out accordingly.

 

[csperoni]

I agree with splitting for this situation. For SNF consolidated billing the professional services are excluded, which means Medicare is responsible for the professional portion. Assuming everyone pays correctly, you wind up with the same total payment, just partially from Medicare and partially from the SNF.
And yes, be prepared to wait and fight for payment from the SNF.

 

[tmcgraw@oracleheartva.com]

We have a denial from Medicare, The procedure code/bill type is inconsistent with the place of service. It is 99215 and G2211. Patient was in a SNf rehab facility and Medicare paid the claim then recouped stated procedure code and pos do not match. I would love some guidance.

 

[ckmiotek]

We have a denial from Medicare, The procedure code/bill type is inconsistent with the place of service. It is 99215 and G2211. Patient was in a SNf rehab facility and Medicare paid the claim then recouped stated procedure code and pos do not match. I would love some guidance.

99215 and G2211 can only be billed with POS 11 or 22 (office or outpatient). If you billed them with these POS that that is a in correct recoup and you should fight it. If you billed those codes with SNF POS (31) then that is a correct recoup. You can only bill SNF codes with POS 31. Hope this helps.