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bpp with nst 76818

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Korbc

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Uncasville , CT
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Hey guy!
quick question, the ultrasound portion took place in our office and we own the equipment but the nst portion took place on L&D and the nst equipment is owned by the hospital. would i use a mod 26 or not on 76818 since half we owned and half we did not and of course our staff performed these.

thanks!
 
I would lean toward billing 76818 with modifier 26 in this scenario.

The biophysical profile (76818) includes both the ultrasound assessment and the NST component, but modifier 26 is based on who owns the technical component and who is providing the professional interpretation.

Since:
The NST equipment is owned by the hospital/L&D.
Part of the technical component of the service was furnished using hospital-owned equipment.
Your provider/staff performed and interpreted the study.

You may not have furnished the entire technical component necessary to support billing the global service. In that case, billing the professional component only (76818-26) would generally be the safer approach. I would also verify how the hospital is billing the NST portion. If the hospital is submitting the technical component associated with the NST, that further supports reporting only the professional component from the physician side.

One question: Is the hospital billing 59025 separately, or is the NST being captured only as part of the BPP (76818)? The answer could affect how the technical and professional components are ultimately allocated.

Dee Daniels
Founder | Elevare Management Solutions
Revenue Cycle Management Consultant
www.elevaremgmts.com
 
Korbc said:
Hey guy!
quick question, the ultrasound portion took place in our office and we own the equipment but the nst portion took place on L&D and the nst equipment is owned by the hospital. would i use a mod 26 or not on 76818 since half we owned and half we did not and of course our staff performed these.

thanks!
Click to expand...
Did the same provider do both? If not, bill 76819 done in the office for provider A and 59025-26,59 for provider B
 
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