Wiki IS IT LEGAL? 93880 and 993882

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MarilynS

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I work for an Internal Medicine doctor. A lab comes into our office and performs the service of the Duplex scan of extracranial arteries. They also interpret and write the results. They do not send any claims to the insurances nor do they bill patients. My doctor wants to charge an 93880 or 993882 for these services, then he turns around an pays the lab who performs these services. I'm not quite sure if this is OK to do. If it is legal then what code would be appropriate? Can someone please help me figure this out? Much appreciated.
 
If a physician doesn't want the expense of the machine and wants to hire the machine and the tech, it can be billed globally under the Physician. Duplex scans and Ultrasounds are the big ones where this option is exercised.
 
I believe you can bill the technical component of these services as a 'purchased service' if you are paying the outside lab to do them for you, but it wouldn't be appropriate to bill the professional component if your physician is not doing the interpretation. The interpretation is a physician service which needs to be billed by the provider who actually performed the service. You could credential the provider who is doing that service for you and have the benefits assigned to your practice but you'd still need to bill with that provider's NPI.

Another consideration you should look into is that some Medicare contractors may require certain credentials to allow you to perform these tests. I've been told that the contractor in our particular area requires a provider who is certified in cardiovascular medicine to supervise the technicians performing certain diagnostic procedures such as these.
 
SO, the proper way to bill for these services is to attach a modifier TC.? The lab does all the work and bills my doctor for the services.
I'm just making sure that is what you are saying.
Thank you
 
I think I may have been mistaken - the most recent updates to the Medicare guidelines do say that the professional and technical components can be purchase from a supplier, so I guess you can bill this globally. Also, take a look at chapter 13, section 20 of the Medicare Claims Processing Manual, link below, regarding anti-markup rules to make sure you're compliant with the regulations of this:

"The B/MAC may pay a physician (or a physician’s medical group) or other supplier for the TC or PC of diagnostic tests (other than clinical diagnostic laboratory tests) that the physician or other supplier contracts an independent physician, medical group, or other supplier to perform. The anti-markup payment limitation applies when the performing physician or other supplier does not meet the criteria for sharing a practice with the billing physician or other supplier. The contracting physician, physician’s group, or other supplier must accept as payment in full the lower of: (a) the acquisition price; (b) the submitted charge for the service; or (c) the fee schedule amount....The billing physician or other supplier must keep on file the name, address, and NPI of the physician or other supplier who performed the anti-markup service."

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c13.pdf

Also, I'd recommend checking any commercial payer contracts you have to ensure that this is allowed under the agreements.
 
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