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Stress Test Unbundling

  1. #1
    Default Stress Test Unbundling
    Medical Coding Books
    Hi everyone,

    I've got a bit of a dilemma. We bill nuclear stresses for one of our freestanding outpatient facilities. Physician group owns the equipment and supervises and reads their own tests. Because of a billing issue with a new software package, we are being instructed to bill 93016, 93017 and 93018 versus 93015. We are also being told we should bill 78465-26 and 78465-TC, etc., in order for the billing software to process our claims correctly. I am strongly opposed to this because it is raising my "unbundling" hackles. If anyone is billing in this manner, I'd like to hear from you. I'd also like confirmation that I am not just imagining this to be a significant problem.


  2. #2
    Columbia, MO
    I would talk to the vendor to have the software "fixed" I cannot imaging any payer reimbursing and it raises my unbundleing hackles as well!

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Jacksonville Florida
    I agree, sounds very fishy.
    Jammie Barsamian, CPC, CCC, CEMC, CCS-P, CPMA

  4. Default
    We do bill the 26 and TC components separately for ours nucs, because we have some of our Drs who own the equpment and some who do not.

    If you look at the allowed amounts, if you add the 26 and the TC amounts together they equal the global amount, if you were to bill it globally. So technically I would not consider it unbundling.

    As for the 93016, 17 and 18, I've never done that. I would check to see if the amounts if added together equal the 93015. If so, then it is obviously you are not billing to gain anything.

    I must warn you though, the gal who does our AR cringes every time she sees that we bill it this way. Often, insurance companies remove modifiers and pay the first claim globally, then good luck trying to get them to understand they are the ones who made the error.

    Sounds odd that it is your billing software is telling you to do this if you do not have to. I would definately find a way to override it. In the long run it would save you so much grief if you did not have to.

    Good luck!


  5. #5

    I work in a free standing cardiology dept and we own our equipment & don not use mods
    we bill:

    A9505x2 units

    Now I am billing in FL also, sometimes if we do not bill for cardiolite & bill for thallius the codes change diffrently too

    Hope this helps


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