ChrisZim
Networker
One of the Cardio offices I code for has a very complicated situation with their holters, and although I've been coding holters for years, we are having problems with the ones for this one location, because the charges they submit are - at different times - 1 or more of all 4 Holter codes: 93224/93225/93226/93227 
confused.
After much back and forth, we finally were able to clarify with Administration that the providers' office owns some holters, and the hospital has some holters of their own.
The cardiologist is an employed provider with an office on campus (for which he carries expense) at the hospital. So that is part of the confusion. Some of the units the office owns, some they don't (POS 11 vs POS 22).
On top of that:
1) some of the Holters they put on and take off in their office,
2) some are put on at/by the hospital outpatient area, but then taken off at the office
Then, because the office is the only place there is a computer that can communicate with the Monitor, all the patients go to the office to have the unit disconnected, and the scan downloaded/printed.
5) So for ALL of them (as far as we can confirm) they are downloaded, scanned & printed at the office.
And finally, for the review and interpretation (93227):
6) the Cardiologist I code for does SOME of the Reviews/interpretations - or -7) The printed scan results are sent back to the ordering doctor for them to review and interpret.
So here's my problem, we are getting denials on POS for some of our codes.
Here's what I believe is correct:
If the Office owns the unit, puts it on, takes it off, scans/download/prints it, and my Cardiologist generates a review and interpretation, then the code is 93224 (what I think of as a "global" code) with POS 11
If the unit belongs to the hospital, then the codes have to be broken out:
93226 POS 11 for the unit being downloaded/scanned/printed at the office (they can't get paid for actually disconnecting, because the hospital is billing that with 93225 on their end)
If the Cardiologist I code for does the review/interpretation report, he can bill the 93227 POS 22.
If the review/interpretation is done by another provider, there is no code to bill because we didn't do it.
We are getting paid for 93227/POS 22, and 93224/POS 11, but I'm getting denials on 93226 - whether POS 11 or POS 22. I've hunted, but cannot find anything in the Medicare guidelines that prevents us billing the 93226 in the office. Any ideas - other than a tall margarita?????
Thanks in advance
confused.After much back and forth, we finally were able to clarify with Administration that the providers' office owns some holters, and the hospital has some holters of their own.
The cardiologist is an employed provider with an office on campus (for which he carries expense) at the hospital. So that is part of the confusion. Some of the units the office owns, some they don't (POS 11 vs POS 22).
On top of that:
1) some of the Holters they put on and take off in their office,
2) some are put on at/by the hospital outpatient area, but then taken off at the office
Then, because the office is the only place there is a computer that can communicate with the Monitor, all the patients go to the office to have the unit disconnected, and the scan downloaded/printed.
5) So for ALL of them (as far as we can confirm) they are downloaded, scanned & printed at the office.
And finally, for the review and interpretation (93227):
6) the Cardiologist I code for does SOME of the Reviews/interpretations - or -7) The printed scan results are sent back to the ordering doctor for them to review and interpret.
So here's my problem, we are getting denials on POS for some of our codes.
Here's what I believe is correct:
If the Office owns the unit, puts it on, takes it off, scans/download/prints it, and my Cardiologist generates a review and interpretation, then the code is 93224 (what I think of as a "global" code) with POS 11
If the unit belongs to the hospital, then the codes have to be broken out:
93226 POS 11 for the unit being downloaded/scanned/printed at the office (they can't get paid for actually disconnecting, because the hospital is billing that with 93225 on their end)
If the Cardiologist I code for does the review/interpretation report, he can bill the 93227 POS 22.
If the review/interpretation is done by another provider, there is no code to bill because we didn't do it.
We are getting paid for 93227/POS 22, and 93224/POS 11, but I'm getting denials on 93226 - whether POS 11 or POS 22. I've hunted, but cannot find anything in the Medicare guidelines that prevents us billing the 93226 in the office. Any ideas - other than a tall margarita?????
Thanks in advance