Wiki POS for interp and report of cardiac tests?

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heycodinglady

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Help! I understand we now bill the interpretation and report of cardiac tests as where the physician performed the interpretation, ie, his office (11). 1. Is this correct? 2. Is this for all cardiac tests such as EKG's, echoes, nuclear perfusion tests? He has the reading equipment in his office, tests are performed in the hospital, hospital owns that equipment). I have previously been billing the 93010 , 93306-26, 93350-26 series and 78465-26 series, as to where the patient was located, IP or OP on the date of service. Do I now bill as the date the physician performed the interpretation? As you can tell, I need help understanding this change so I can continue billing these correctly and hopefully continue getting reimbursed correctly.:confused: Thanks for any help. Sue
 
Sue,
I do billing for radiology interpretations also so this is a VERY important issue with my office. The CMS Guidelines state that if the interp is performed in a hospital setting use POS 22 (we also were using 21 and 23 when indicated)
I think that if his/her office is in a hospital then you would use POS 11. I am going to listen to 2 different teleconferences given by our Medicare carriers (I bill for two different states) on this subject - one on Weds and one next Tuesday in hopes of getting betting clarification.
Debby
 
Hi, Debby
I'm from Puerto Rico, with all the respect that the other people think regargin the POS,
I think the the POS is ever, where you performed the study.
If the patient is inpatient, it would be ever = 21
If the patient is outhospital , = 22
and if the pt. is at the office = 11, eveeeeeerrrr !!!
I work for a big group of radiology inside the Hospital and manage all kind of patient
Remember, this is my personal experience for almost 22 years radiology BASE
Im personally coder and auditor, ect
ALways remember at all of POS, who is the machine owner ?
At POS 22, 21, 23 you have deal with the ADM hospital to bill, in many insurance, ei, advantages, medicare , tricare, bcbs, the part of TC if is yours, if not, you can bill
your part 26, without any problem
Hope this help you
Mmail
 
heycodinglady said:
Help! I understand we now bill the interpretation and report of cardiac tests as where the physician performed the interpretation, ie, his office (11). 1. Is this correct? 2. Is this for all cardiac tests such as EKG's, echoes, nuclear perfusion tests? He has the reading equipment in his office, tests are performed in the hospital, hospital owns that equipment). I have previously been billing the 93010 , 93306-26, 93350-26 series and 78465-26 series, as to where the patient was located, IP or OP on the date of service. Do I now bill as the date the physician performed the interpretation? As you can tell, I need help understanding this change so I can continue billing these correctly and hopefully continue getting reimbursed correctly.:confused: Thanks for any help. Sue
Click to expand...

Hi Sue,

This is how I understand it:

The POS must be billed where the interpretation is performed. It says in the MLN # MM6375 that if the interpretation is performed in the hospital setting, the POS code is "hospital outpatient" (POS 22). If its read at the office or dr's home, then use POS 11 or 99

The DOS isn't effective until July 1, 2010. So you can still bill the DOS as the date the actual test was performed. After that though, we have no choice but to bill the DOS as the actual date the dr did the interpretation. Hope all that makes sense. If you have anymore questions just let me know :D
 
Mmail,
Thanks for your response. I, too have been doing billing and coding as long as you have and have always used POS 21, 22 or 23 for xrays, EKGs, Echos, etc. done at the hospital. This new Medicare transmittal is stating to use POS 22 for interpretations performed in the hospital setting. Now if that setting meets the definition of "office" then you would use POS 11. My opinion is that they do not care where the patient is, they just care about where the radiologist is when he does his interpretation. This new ruling (transmittal) from Medicare is driving our office crazy and I would love to hear from other billers as to their opinions. Thanks!!!
Debby
 
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We have been discussing this change request in our office today as well. I am interpreting this to mean if the physician is in the office when he reads the tests (regardless of where the patient was when the test was performed), that we are to bill 11. If the doctor read the tests at the hospital, bill 22. Our dilemma is that we have no idea where the doctor was when he read all of these tests. We do interps for several places, and our physician could be at the office, or the hospital when he reads. Any thoughts on the best place to start (either at CMS or local Medicare contractor) to find an answer to this?
 
I get the difference between the office (11) and hospital setting, but if the doc is reading at the hospital for an inpatient, are we to bill it as out-patient (22)?
 
jtb57chevy said:
I get the difference between the office (11) and hospital setting, but if the doc is reading at the hospital for an inpatient, are we to bill it as out-patient (22)?
Click to expand...

That is how I read it. I started billing mine as outpt and told the follow up girls to keep an eye out on these to see if they pay or deny.

Also, has anyone heard if the other carriers are following this new POS/DOS rule?
 
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