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Urodynamics Split Billing

sarahpoe

Contributor
Messages
13
Best answers
0
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

Contributor
Messages
14
Location
Kentwood, MI
Best answers
0
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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