Wiki Medicare denying xrays for pa's/np's???

[moodymom]

MEDICARE IS DENYING XRAYS FOR OUR PA'S AND NP'S!!!
THIS IS A HUGE HIT FOR OUR ORTHO OFFICE!! THEY ARE STATING THIS IS A REACTIVATION OF AN OLD EDIT. ANY SUGGESTIONS? ANYONE ELSE FAMILIAR WITH THIS?

 

[johnmeyer]

This is news to me. That I know of, Medicare is paying us for all our x-rays regardless of the status of the patient or who is ordering the x-rays. Also, that I know of, the only Medicare denials we’ve gotten recently were due to coding issues (i.e. 73562 for knee with Dx of 719.45 hip pain).

 

[fhysong]

We got hit by this too. We found out through many phone calls to Medicare that the PA can't be paid for the global x-ray anymore. They have yet to publish the policy. We were told they will only pay the professional component due to licensure of the PA. We are resubmitting all of our x-rays that our PAs did with a 26 modifier. We are billing the TC component under the MD that was supervising for that day. These are the instructions we received from Medicare.

 

[cluke]

Can anyone tell me which Medicare carrier they are hearing this from? I have not notice this yet here in Michigan.

Thank you.

 

[dstruve]

How are you doing with the refile's on these xrays? We are now being denied the professional componant billed under the PA's as being included in the office visit, but they are paying the technical componant billed under the supervising physician. Anyone else having this issue?

 

[mitchellde]

is the PA allowed to provide the official professional interpretation of the xray in your state? some allow this and others require a radiologist. Also you must have a separate radiology interpretation report dictated by the one billing the professional interpretation. This is not a blurb in the progress note. If you have these things then you appeal.