Wiki Radiology Billing for Part A

[LadyJ317]

Help.......

I do coding and billing for physicians but we are contracted with a hospital to do our Radiology Services through. We are expereincing some major denial issues and need some MAJOR help. Since I am clueless on Part A, I really need some good concrete information.

For example we are billing out 70553 and 70553 and A9579. A9579 is denied due to it is inclusive to the codes where "with contrast" is included in the code. I know that A9579 is denied with a denial of "N" which means packaged. I get that. 70553 has a Status Indicator of Q3 and 70544 has a Status Indicator of Q3. When we bill them without modifiers, 70553 is paid and 70544 is denied with SI "N". When we bill with a modifier 59 on 70544, 70544 is paid at a higher rate than 70553 (more than double) and 70553 is denied with Status Indicator "N". Is there a way to get both codes paid or should we not be performing both procedures on the same day?

Thanks for any help,

Jennifer, CPC

 

[Joanna S. Johnson]

70553 and 70554

Hi Jen,
When we were in the hospital we were contracted do the MRI's. Not sure why you are billing Part A as that is what the hospital bills. Part B is for the doctor. We billed Part B global. Do you own the MRI equipment? What is the contract between you and the hospital? are you based in the hospital? Do you pay rent to the hospital? These things decide who you bill and how you bill. Normally you do not bill 70553 and 70554 together unless a separate diagnostic MRI is performed and it also must be ordered. We were hospital based for 20 yrs and I don't recall ever doing 70544 Functional MRI.

 

[LadyJ317]

Joanna,

I do not know what the contract is. They own the equipment we do not, we are not located in the hospital. We are 2 complete different companies. We do bill the physician side with modifeir 26 and we have no issues with that side. We bill 70553-26 and 70544-2659 and get paid for both codes. However the contract is setup, when we bill the hospital claim goes out it goes out on a UB04 claim, so it is processed as Part A.

 

[pjorwin]

Hi Joanna,
Just an fyi, not all UB-04 claims are considered 'in-patient'. I work for a skilled nursing facility and we have patients that are their and paid under the medicaid plan. However, when they received therapy services we bill them on a UB-04 but the services are considered under the part B because they are not in the snf on a Medicare A stay. I hope this makes sense...
Paula