Wiki Pacemaker Checks with Modifier TC/26 correct coding help please

[csorensen21@yahoo.com]

Our Boston Scientific and Medtronic reps come to our office about every 6 months for pacemaker checkups. We generally schedule the follow up visit that same time for the patients. We bill the office visit with a modifier 25 and we do not attach any modifier to the pacer check code (93288-93279-93280) Two of our reps are telling m<script id="gpt-impl-0.23097845584280302" src="https://partner.googleadservices.com/gpt/pubads_impl_81.js"></script>e two different things. I am trying to seek clarification and concrete evidence that we have to bill the modifier 26 on the pacemaker check code when the pacer rep comes to our office uses our equipment and the physician is present?

Can someone help me with this so I can figure out if we are getting overpaid or underpaid for procedures?

We are in the state of Michigan.

Thank you,

 

[Misty Dawn]

Our Boston Scientific and Medtronic reps come to our office about every 6 months for pacemaker checkups. We generally shedule the follow up visit that same time for the patients. We bill the office visit with a modifier 25 and we do not attach any modifier to the pacer check code (93288-93279-93280) Two of our reps are telling m<script id="gpt-impl-0.23097845584280302" src="https://partner.googleadservices.com/gpt/pubads_impl_81.js"></script>e two different things. I am trying to seek clarification and concrete evidence that we have to bill the modifier 26 on the pacemaker check code when the pacer rep comes to our office uses our equipment and the physician is present?

Can someone help me with this so I can figure out if we are getting overpaid or underpaid for procedures?

We are in the state of Michigan.

Thank you,

Hi, You can not bill for the technical service of a remote or in-person device evaluation if the device representative performs the check. In order to bill technical service, physicians must either perform the procedure or supervise a Qualified Staff. Device Reps are not "Qualified Staff" because they do not work for the physician/provider. Per CMS claims processing guidelines "supervision requirements for physician billing is not met when the test is administered by supplier personal regardless of whether the test is administered at the physician's office or at another location".

Also the ownership of the device monitoring and programming equipment is not a determining factor. The technical service of these codes include data acquisition, receipt of transmissions and technical review, technical support and distribution of results. If a device industry rep is involved in performing the tech service the physician may only bill the professional service (i.e. physician analysis, review and report).

The information is per Heart Rythm Society, American College of Cardiology and CMS processing guidelines.

HTH, Misty