Wiki Device Checks with Representative from Device Company Present

[aforsythe]

Our physician office has conflicting ways of billing device checks when a representative is present from the device company.

We are disagreeing that a 26 modifier needs to be appended to all charges when a representative is present no matter who performs the check and who owns the equipment.

We own the equipment and the techs are employed by the provider office; in this instance would we add the 26 modifier?

If the representative uses equipment of the company they are from a 26 modifier would then be added correct?

Thanks.

 

[smoore123]

Billing Globally or with Modifier 26 for Programming and Interrrogations

Good Afternoon,

We recently just visited this issue at our facility and verified how we can bill this with NGS. If the provider or staff employed by your office/organization are retrieving the data (not the representative from the device company) you can bill these globally without the TC or 26 modifier. IF the representative from the company is physically retrieving the data then you can not. Below is the clarification I received from NGS regarding this:

This is in response to our telephone conversation with regard to billing globally for ICDs and SICDs in an office place of service setting.

The codes you list below for ICDs and SICDs all have a PC and a TC component; therefore, if your office physician staff work includes obtaining, analysis, review and report, connection, recording, and disconnection with iterative adjustments to the device to test the function of the device, then you would be accurate to bill these codes globally.

Important to know?.

The professional component (PC): use of modifier 26 is the physician work portion of diagnostic tests (e.g. interpretation). Medicare allows for the PC of radiology services furnished by a physician to an individual patient. The interpretation of a diagnostic procedure shall include a written report.

The technical component (TC): use of modifier TC is the performance of a diagnostic test, that is, physician and equipment costs. The technical portion of diagnostic procedure shall include an imaging report.

So, to bill these codes globally, the documentation shall include programming device evaluation (in-person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with physician analysis, review and report; (single, dual, or multiple lead) implantable cardioverter-defibrillator systems codes 93282, 93283, 93284 and including analysis of heart rhythm derived data elements for 93289.

I hope this helps. This would pertain to pacers also.