Gastroenterologist office billing for professional and facility components for ultrasound 76700

katy1

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Hello we are a GI practice billing for the professional and facility component of the ultrasound. Our own physician orders the ultrasound and the ultrasound tech does the ultrasound. The physician interprets the report and owns the ultrasound machine. My question is do we send bill for 76700 complete abdominal ultrasound without any modifiers to indicate we are billing for professional and facility?
 

katy1

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My provider wanted me to clarify if we could send two bills if the Ultrasound is being done at he's ASC facility. He owns the machine so we wanted to know if we could bill both components Professional since he is ordering the ultrasound at he's private practice and facility since it is being done at the ASC. In that case would we send two claims one in a CMS1500 with or without the modifier 26 for the professional component and the facility claim on a UB04 with or with out the modifier TC for the technical component. Or do we send both claims without any modifiers and bill only 76700 on both claims. Can you clarify what would be the correct way to bill this in this scenario please.
 

csperoni

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This sounds a little more of a legal question than a coding question. I do not have expertise in this area.
If you are splitting the bill for legal or tax reasons, your physician bill would go -26 and facility with -TC. You definitely would not send both bills for both professional and technical.
I would first question as to why the provider is even wanting this. Sometimes, the provider THINKS he/she gets more money billing separately, but you do not. You get the same payment to the penny, with additional work.
For example, 76700 here's the Medicare payment for my area
Medicare Fees
NationalAdjusted26TC53
Facility$124.57$149.92$45.71$104.21$0.00
Non Facility$124.57$149.92$45.71$104.21$0.00

I would get the same $149.92 whether 1 bill and 1 check, or whether 2 bills and 2 checks (1 to physician for $45.71 and 1 to facility for $104.21).
Sometimes there are legal, liability, or financial reasons this is done, but you should ask a lawyer or accountant those questions.
Hope I shed at least a little more light on this for you.
 
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