Wiki Pulmonary Function Medicare Denials

[TiffianyEdwards]

So I am about to take over or start learning Pulmonary, and we are getting denials from Medicare on 94060, 94726, 94728, 94729, without a 26 modifier. They are saying it needs a modifier. I am trying to understand the rationale behind why it needs to be billed with a 26. They are done at the hospital, on an outpatient basis. Can someone please explain to me why it needs to be billed with a 26. We do the entire thing, so it's a global charge not a read.
Also I have been unable to find an LCD for this, I am in WY, but can't seem to figure out the medicare website.

Any help would be much appreciated.

Thanks,
Tiffiany

 

[mssalemny]

Does your practice own the equipment?

If not, it is considered the physician services only and the hospital will bill the technical component of this testing.

 

[TiffianyEdwards]

umm

They do them in the clinic and at the hospital so am assuming the clinic does own the equpiment and maybe the hospital owns the other equipment so following your logic, the clinic PFTs should be globals and the hospital PFT's should be reads and would need a 26 mod correct?

 

[bmasser]

It may be the location code on the professional claim. If it's 22, it is assumed that only there will be a facility charge for the TC portion.

 

[renedepuy]

Modifier Clarification

We are doing pulmonary function tests in the office. We are billing for the test on one day as follows:

94060 - TC
94726 - TC
94729 - TC

When the physician interprets the test the next day we are billing:

94060 - 26
94726 - 26
94729 - 26

Is this correct?

 

[TiffianyEdwards]

modifier question

We are doing pulmonary function tests in the office. We are billing for the test on one day as follows:

94060 - TC
94726 - TC
94729 - TC

When the physician interprets the test the next day we are billing:

94060 - 26
94726 - 26
94729 - 26

Is this correct?

Who owns the equipment? if it is always one of the doctors that reads the study the next day you would just bill it as a global, no modifiers.

We own our equipment, two pulmnologists in clinic, they do pft or any dx testing in office they bill no modifiers. if the hospital does a pft on a patient and the doc reads that study they bill with a 26 mod. I only do profee coding I have never used a TC modifier I believe that is only for hospitals.