Wiki info for box 31 on hcfa claim for from facility

AHearley

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Is it appropriate for the facility billing CPT codes with modifier TC to be putting the radiologists name in box 31 on their HCFA? He is in an independent practice but is contracted to read all of the images for the facility/hospital.
His practice bills all services with modifier 26.
Insurance is denying our charge indicating this is incorrect. That hw cannot be on both claims. As it is an NCCI edit??????
 
I think the insurance company is giving you incorrect information. There is no overlap between the technical component and the professional component. There shouldn't be any issues with the TC being on one claim and the 26 being on another, and it wouldn't matter if the two claims were for the same provider or different providers.

Incidentally, hospitals don't bill technical components on a HCFA form (it's now called the CMS-1500 form), they use a UB-04 form, and there's no box 31 on that form.
 
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I would agree that the insurance is incorrect. They keep stating that the coders should know this is an ncci edit????? And my radiology group is independent and we bill all our charges with modifier 26 when appropriate of course. under our own tax id on a hcfa 1500. So the clinic is also billing on a hcfa 1500 however they are using TC modifier BUT they are putting the radiologist name in box 31 as well but under their tax id number. The insurance is stating that since the facility put his name on their claim it can't be on both???? I have never heard this in all my years and it has never been an issue before..
example,
my radiologist reads xrays for an orthopaedic group at a clinic. They are billing with the TC but are putting his name in box 31 on their HCFA.
We then bill for his charge using 26 modifier and POS appropriate . Is it correct that the facility put his name in box 31 then their info in box 32 and 33
 
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I would agree that the insurance is incorrect. They keep stating that the coders should know this is an ncci edit????? And my radiology group is independent and we bill all our charges with modifier 26 when appropriate of course. under our own tax id on a hcfa 1500. So the clinic is also billing on a hcfa 1500 however they are using TC modifier BUT they are putting the radiologist name in box 31 as well but under their tax id number. The insurance is stating that since the facility put his name on their claim it can't be on both???? I have never heard this in all my years and it has never been an issue before..
example,
my radiologist reads xrays for an orthopaedic group at a clinic. They are billing with the TC but are putting his name in box 31 on their HCFA.
We then bill for his charge using 26 modifier and POS appropriate . Is it correct that the facility put his name in box 31 then their info in box 32 and 33
If the provider is not employed by the clinic performing the TC, then no, that provider's name should not be in box 31. If they are employed (e.g. they are there supervising the TC at the time and assign their benefits to the clinic), then it's correct. Either way though, there's no NCCI between these two services. There's no reason to deny the interpretation because of something going on with the TC claim. If the phone reps you are speaking to do not understand this and can't give you a satisfactory explanation or way to resolve this, then you need to escalate the issue to a supervisor or to a network representative. Payer phone reps almost never have a coding background, so don't accept an explanation from them that you know is incorrect. Your only other option is to contact those other clinics that the payers say are using your provider's name as a billing provider and try to get them to stop. But that really shouldn't be your responsibility. If your provider isn't credentialed as a billing provider with that clinic, then the payers should be denying their claim, not yours.
 
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