Wiki Cardic Stress Test (93017) with MPI (78542)in hospital owned Physicians office

[Chlrtrep]

Hello I am a Cardiac Administrator and I am looking for some insight on physician billing for a Cardiac treadmill Stress test with a Nuc Med MPI Scan performed in a physician's office.

We are currently in the process of acquiring a physician group that currently performs these services in their office. We are purchasing the group and all the equipment and the physicians will still perform these procedures in their office. Could you provided some recommendations on how this will now be billed since all physicians, staff and equipment will be hospital owned? Additionally we are considering using a Nuc Med mobile services while we update the scanners in the building. I would appreciate your insight on how this differs from procedures being performed in an outpatient setting in a hospital.

My initial thoughts are that the hospital owned physician's office will bill 93016 and 93018 and 75842-26 for their services and the facility would bill 93017 and 75842-TC.

I would appreciate any feedback. I like to get perspective from different sources.

Thank you

 

[thomas7331]

Your choice of codes is correct if the billing is going to be split between the hospital and the providers. The physician claim would report a place of service 22 for outpatient hospital if the office is located on campus, or place of service 19 if off campus. The facility would also be able to bill for the isotopes and any drugs administered during the procedure in addition to the TC codes above.

However, before planning how you'll code these, you should take a close look at the CMS regulations regarding Provider-Based Departments and also contact your contracted payers to get their direction on whether or not they allow split bills for hospital-owned physician practices. For Medicare, practices acquired by hospitals after November 2, 2015 that are off-campus are no longer paid under OPPS so this may play a role in how the hospital wishes to bill. If the physician office is off campus and the hospital bills for the facility fee, the hospital will need to append a PN modifier to report this, and there will be a payment reduction from the hospital's OPPS rate to essentially allow a payment that would be equivalent to what the payment to a private practice would be. Due to the payment reductions, the hospital might prefer to credential this entity as a freestanding physician practice and not split the bills - I believe this is an option too. The rules governing provider-based departments have always been challenging and recent changes have made it even more difficult, so I'd recommend taking a close look at this first - the provider-based status of the practice will ultimately govern all of your coding decisions.

 

[Chlrtrep]

Your choice of codes is correct if the billing is going to be split between the hospital and the providers. The physician claim would report a place of service 22 for outpatient hospital if the office is located on campus, or place of service 19 if off campus. The facility would also be able to bill for the isotopes and any drugs administered during the procedure in addition to the TC codes above.

The rules governing provider-based departments have always been challenging and recent changes have made it even more difficult, so I'd recommend taking a close look at this first - the provider-based status of the practice will ultimately govern all of your coding decisions.

Thomas,

Thank you for this thorough explanation. I appreciate your quick response.

Charles