Urodynamics Split Billing

sarahpoe

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I am trying to obtain information of how to bill for urodynamics that were performed by an NP, but interpreted by a physician on a separate date. Both providers are in the same practice, and own the equipment. Is it appropriate to bill for example:

51728,TC under the NP on the date the test was performed (04/02/16), and

51728,26 under the physician on the DOS he interpreted the test (04/04/2016).

This is not "incident to" as the physician is not in the suite when the test is performed. The NP has his own NPI to bill Medicare. I have been told in the past that 51728 should be billed w/ no modifiers since the providers are in the same practice and the service cannot be unbundled.

Any guidance is much appreciated.

Thank you!
 

smh

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Byron Center, MI
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Correct

You would be correct, I bill multiple Urodynamics per week. They are payable with TC/PC modifiers. The only insurance I have come across with issue is Blue Cross Blue Shield of Michigan that requires you to bill the PC with the same DOS of the testing (even though read on a different date.) Also, they are currently having issue with 51784 and their system. They're working on it as it is only paying once (if broke into tc/pc because we have different locations and supervising doc can be different than the interpreting doc. In those cases, we have to split bill with same DOS.) All other insurances I have not had issue with.
 
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