fluoroscopy in ASCs

bmiller

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What, if any, certifications/requirements does an ASC have to have to be able to bill for fluoroscopic guidance? Are they required to have some kind of diagnostic radiology cert?
Thanks,
 

Deadpd

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Fluoroscopy

I work in an ASC and we own the equipment, and we've tried to bill the 'TC' modifier. We have very limited success in reimbursement for the procedure. Hope you have better luck. 'TC' is the Technical Componet when you own the equipment, and 26 is when the dr bills for the use of the equipment. Most the procedures we do the fluoroscopy is included in the total price of the procedure.
 

cconroycpch

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Fluoroscopy in ASC's

There is no other certification as an ASC that you can get to cover the fluoroscopy. You will only get paid from a limited amount of insurance companies. However, there are alternatives depending on the volume of cases your facility performs and the insurance mix of your center. Let me know if you are interested.

Also, Medicare will begin to pay for some radiology codes in 2008, but not the 77003.
 

mbort

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You should code for the fluoro regardless of the carrier, consistency is important. A patient may come in today and is verified as having BCBS however two months from now you find out its actually workers comp, you want to make sure that you coded/billed for it the same for both carriers. BCBS may not pay for it, but workers comp or carriers with contracts for a % of billed charges usually do.
 

cconroycpch

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I disagree with sdyches. You do need to indicate the 26 or TC modifier is you are billing for the professional or technical component. Only, if you are billing globally, then you would not use a modifier. The facility would only be billing for the technical compent and should use the TC modifier.
 

Onelm

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modifier tc or 26?

when you do this at this office you should use 26 right? Our doctors owns ans uses it. so which one should I use? has the cpt changed, Most of the insr. dont pay for it!!!! little help please!!!!:confused:
 

cconroycpch

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when you do this at this office you should use 26 right? Our doctors owns ans uses it. so which one should I use? has the cpt changed, Most of the insr. dont pay for it!!!! little help please!!!!:confused:
If your physician owns the equipment and uses it during procedures, you do not use any modifier. This would mean that you are billing globally (for the technical and professional components). You also state that most insurances do not pay for it. What is their denial reason? Are you being denied for both the professional and technical components? What insurance companies are denying?
 

tcraig

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fluro is asc

I have another question regarging fluro in an asc. We are a pain clinic. We do one surgical session, and I bill on fluro with a TC modifier. I was recently audited by an outside coding person who told me I needed to bill a fluro with every injection we did, with a 59 modifier. Any feedback?
 

sdyches

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I don't know for sure, but it seems to me that if the ASC owns the equipment and read them, there would be no need for a modifier except the SG for ASG for Medicare. We get paid for them. I would appreciate any input.
 

cconroycpch

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I don't know for sure, but it seems to me that if the ASC owns the equipment and read them, there would be no need for a modifier except the SG for ASG for Medicare. We get paid for them. I would appreciate any input.
sdyches - I am curious as to what state your facility is in that you are getting reimbursed for the fluoro and what insurance companies are reimbursing you and how much. Also, does your ASC facility have a physician employed there that does the reading of the fluoro? Your facility does not pay the physician for his service, you can not bill for the professional component and would therefore need to have the TC modifier on your bill for the fluoro.
 

acuaria76

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Flouro

Our facility does not own the equipment. We have a tech that comes over from an imaging center next door and she operates the equipment while the surgeon does the procedure. In this case, should I be billing the flouroscopy with the TC modifier? Please help!!!
 

codegirl0422

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Just a thought

I bill for my GI doctors and they also have their own ASC, which I also bill for. If fluroscopy is used, I bill the ASC with TC modifier and the physician porition with the 26 modifier. They way it works for us is the ASC owns the machine not the physician. The ASC and the physician are separate, different tax id's and everything. My doctor's have different provider numbers for the ASC than they do for their office. This is different than if done in the office. Yes there you could bill without modifiers because physician and technical are billed under the same tax id #/provider #. Our insurance's deny it as global to the procedure (CO97), mainly BC of AL denies but there are others

If your physician owns the equipment and uses it during procedures, you do not use any modifier. This would mean that you are billing globally (for the technical and professional components). You also state that most insurances do not pay for it. What is their denial reason? Are you being denied for both the professional and technical components? What insurance companies are denying?
 

codegirl0422

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I am not positive, but it shoulds like the tech is doing the TC portion. Is the doctor reading anything, etc that maybe a 26 modifier could be used. Do you bill for the facility and physician. For the facility, you may not be able to bill anything but for the physician bill the 26 modifier. See my other post within this thread, I dont know if this helps or not.

Our facility does not own the equipment. We have a tech that comes over from an imaging center next door and she operates the equipment while the surgeon does the procedure. In this case, should I be billing the flouroscopy with the TC modifier? Please help!!!
 

dawnee

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ascbiller

Does anyone know when billing for a 62290/ 62291 do you bill for the epidurogram(72285/72295) per level or just once, and also for radiofrequencies do you bill the fluoroscopy per level or just once? Please help!!!
 

codegirl0422

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72285 72295 per level
fluoroscopy only once

Does anyone know when billing for a 62290/ 62291 do you bill for the epidurogram(72285/72295) per level or just once, and also for radiofrequencies do you bill the fluoroscopy per level or just once? Please help!!!
 

gared111

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I have another question regarging fluro in an asc. We are a pain clinic. We do one surgical session, and I bill on fluro with a TC modifier. I was recently audited by an outside coding person who told me I needed to bill a fluro with every injection we did, with a 59 modifier. Any feedback?
Sounds like that auditor needs to go back to school! You only bill it once unless multiple sites are being injected (example, dr injects C2-3 & also L4-L5 in the same session...you can bill a 2nd flouro with a TC 59( modifier). If multiple injections are performed in one region (example Lumbar L1-2 L3-4 L4-5) you can only bill it once.
 
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jennifer.cooper

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You can't append the modifier -26 and TC for the same physican on the same date. If you own the equipement and the same doc reads the report you would use the global billing code which is not modifiers should be appended for the global billing.

I have seen claims come in that some people will bill it on a different line item. Some even have one Line item 99999-26
99999-TC-59
This will not get paid EVER or at least not by my company.

sdyches you are correct if both TC and -26.
 

coderlady

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Radiology in the ASC

Does anyone bill regular x-ray codes in their ASC?? Not just 76000? I'm wondering what the guidelines are now that Medicare allows some radiology codes to be billed in an ASC. i have a case where the patient had a great toe fracture and surgeon says, "we brought in a mini C-arm and took AP and lateral views of the great toe and note that we were in bone (for pinning) and that we did not appear to be in the joint and our reduction was adequate." Is this enough to bill for 73660? Haven't done this before so want to make sure I know what I'm doing..... Thanks all!!! :)
 
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