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fluoroscopy in ASCs

  1. Default fluoroscopy in ASCs
    Medical Coding Books
    What, if any, certifications/requirements does an ASC have to have to be able to bill for fluoroscopic guidance? Are they required to have some kind of diagnostic radiology cert?
    Thanks,

  2. #2
    Default Fluoroscopy
    I work in an ASC and we own the equipment, and we've tried to bill the 'TC' modifier. We have very limited success in reimbursement for the procedure. Hope you have better luck. 'TC' is the Technical Componet when you own the equipment, and 26 is when the dr bills for the use of the equipment. Most the procedures we do the fluoroscopy is included in the total price of the procedure.

  3. #3
    Default Fluoroscopy in ASC's
    There is no other certification as an ASC that you can get to cover the fluoroscopy. You will only get paid from a limited amount of insurance companies. However, there are alternatives depending on the volume of cases your facility performs and the insurance mix of your center. Let me know if you are interested.

    Also, Medicare will begin to pay for some radiology codes in 2008, but not the 77003.

  4. #4
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
    Default
    You should code for the fluoro regardless of the carrier, consistency is important. A patient may come in today and is verified as having BCBS however two months from now you find out its actually workers comp, you want to make sure that you coded/billed for it the same for both carriers. BCBS may not pay for it, but workers comp or carriers with contracts for a % of billed charges usually do.

  5. #5
    Location
    Augusta chapter
    Posts
    17
    Default
    From my understanding, if you own the equipment-you do not have to utilize modifiers (26 or TC)SAD

  6. #6
    Default
    I disagree with sdyches. You do need to indicate the 26 or TC modifier is you are billing for the professional or technical component. Only, if you are billing globally, then you would not use a modifier. The facility would only be billing for the technical compent and should use the TC modifier.

  7. #7
    Unhappy modifier tc or 26?
    when you do this at this office you should use 26 right? Our doctors owns ans uses it. so which one should I use? has the cpt changed, Most of the insr. dont pay for it!!!! little help please!!!!

  8. #8
    Default
    Quote Originally Posted by Onelm View Post
    when you do this at this office you should use 26 right? Our doctors owns ans uses it. so which one should I use? has the cpt changed, Most of the insr. dont pay for it!!!! little help please!!!!
    If your physician owns the equipment and uses it during procedures, you do not use any modifier. This would mean that you are billing globally (for the technical and professional components). You also state that most insurances do not pay for it. What is their denial reason? Are you being denied for both the professional and technical components? What insurance companies are denying?

  9. Default
    Has anyone tried the new code 20986.

  10. #10
    Default fluro is asc
    I have another question regarging fluro in an asc. We are a pain clinic. We do one surgical session, and I bill on fluro with a TC modifier. I was recently audited by an outside coding person who told me I needed to bill a fluro with every injection we did, with a 59 modifier. Any feedback?

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