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xrays in ASC

  1. Default xrays in ASC
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    We own an ASC and our Dr's are taking and reading the xrays in the ASC...can I bill the xray CPT without modifiers since we're doing both the professional and technical components? And if not, please guide me to "official" source on the subject to provide for my Dr. Thank you!

    Jenna

  2. #2
    Location
    Grand Rapids, Michigan
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    Default ASC x-rays.
    This question had come to me a few years ago. Unfortunately, I no longer have the information in my possession. However, there was an article in Orthopedic Coders Pink Sheet that did allow this with the condition that there be a separate x-ray report. This report must be separate and distinct from the op note.

    I am sorry I can't give you the article, but hope this helps.

  3. #3
    Default
    Here's some help:

    Knowing when to bill globally and when to segment a code into the professional component (modifier 26) or the technical component (modifier TC) is crucial in order to properly bill all of the services rendered.

    When a service is billed globally, the provider is reimbursed for the equipment, supplies, and technical support, as well as the interpretation of the results and the report.

    However, if someone else performed the technical aspects of a service, and the provider only interpreted the results and wrote a report, modifier 26 is necessary to indicate that the provider should receive reimbursement only for the professional component. Similarly, the technical component, modifier TC, includes billing only for the equipment, supplies, technicians, and facility, but not the interpretation of the service.

    Strictly following these modifier guidelines is essential to your bottom line, because reimbursement will be higher when a code is billed globally than when it's billed with modifier 26 or TC appended to it. Many specialties have codes that can be billed according to these guidelines, including the following:

    Radiology: Most radiology codes, including ultrasounds, x-rays, CT scans, magnetic resonance angiography, and MRIs may be billed with modifier 26 or TC, or with no modifier at all, indicating that the provider performed both the professional and technical services.

    For example, an orthopedic surgeon sees a patient in his or her office for a broken ankle. The surgeon requests that x-rays of the patient's ankle be taken in his office. The surgeon would bill 73600, radiologic examination, two views.

    Because no modifiers are appended to the code, the surgeon is indicating to the third-party payer that he or she performed both the technical component and the reading and interpretation of the x-rays for this patient.

    If the x-ray were taken elsewhere, such as in a hospital, the hospital would bill the code 73600-TC, indicating that the hospital is billing only for the technical component. The radiologist at the hospital who read the x-ray would also bill the code 73600-26, indicating that he or she read and interpreted the x-ray and wrote a report concerning his or her findings.

    Pathology: A pathologist may perform a gross and microscopic examination of an ovary, code 88305, during a surgery in a hospital. Under the circumstance that this pathologist bills independently, the hospital would bill the technical component 88305-TC, and the pathologist would bill for just services using the code 88305-26, billing for just the interpretation and the pathology report.

    Obstetrics: A prime example of an obstetric code that may require modifiers is 59025, a fetal nonstress test. If the provider only does the interpretation and writes a report of the results of the test, he or she would bill the service as 59025-26, fetal nonstress test, interpretation and report only.

    This probably would occur if the test is performed in the hospital, either inpatient or outpatient, and the hospital bills 59025-TC, indicating that it is billing only for the technical component. However, when the provider renders both the interpretation and the technical part of the service, usually in the provider's office, the fetal nonstress test would not need any modifiers and be billed just as 59025.

    Cardiology: An example of the use of the modifiers 26 and TC when billing a cardiology code would be 93303, transthoracic echocardiography for congenital cardiac anomalies, complete. In this case, the provider would bill this code with a modifier 26, 93303-26, specifying that the only services that he or she provided were the interpretation and the report. The technical portion would be billed by the hospital as 93303-TC.

    Exceptions to the rules
    There are some exceptions to the modifier TC and 26 rules, and the codes that fall under these exceptions should be billed by individual code indicating whether the code is for the professional or technical component or whether the code is a global code. For example, when code 93000, EKG, is used, this explains that the provider rendered the service of a routine EKG with at least 12 leads with interpretation and report.

    For example, if Mrs. Smith sees her cardiologist for a routine visit, and an EKG is done in the office with interpretation and a report by the provider, code 93000 would be billed. However, if the patient has the EKG performed in the outpatient department of a hospital, and the readings are sent to her provider, then the hospital would bill 93005, tracing only without interpretation and report, and the provider would bill 93010, interpretation and report only. Rather than adding a modifier, each situation requires its own unique code.

  4. #4
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    ENGLEWOOD/DENVER
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    chances are that the surgeon is capturing the 26 component. Unless you have a radiologist that is on staff at the ASC that is doing the interpretations on ASC letterhead, then it is highly unlikely that you will be able to capture that component. The radiologist would also need to be on the ASC payroll.
    Mary, CPC, CANPC, COSC

  5. Default
    Quote Originally Posted by mbort View Post
    chances are that the surgeon is capturing the 26 component. Unless you have a radiologist that is on staff at the ASC that is doing the interpretations on ASC letterhead, then it is highly unlikely that you will be able to capture that component. The radiologist would also need to be on the ASC payroll.
    Thank you Jackie for the great info! We have been billing all of our xrays out of our ASC with the -26 & -TC...but since we own the equipment, it's our Dr taking the xrays AND reading them...I was wondering if we could bill globally. I have heard before about the "must have a Radiologist interpret the xrays in order to bill the global xray cpt" thing...but Mary, I cannot find that in writing from an "official" source to show my Docs. Do you know where I can find this? Thanks again for all the help!
    Jenna

  6. Default Supplies
    Quote Originally Posted by jgf-CPC View Post
    Here's some help:

    Knowing when to bill globally and when to segment a code into the professional component (modifier 26) or the technical component (modifier TC) is crucial in order to properly bill all of the services rendered.

    When a service is billed globally, the provider is reimbursed for the equipment, supplies, and technical support, as well as the interpretation of the results and the report.

    However, if someone else performed the technical aspects of a service, and the provider only interpreted the results and wrote a report, modifier 26 is necessary to indicate that the provider should receive reimbursement only for the professional component. Similarly, the technical component, modifier TC, includes billing only for the equipment, supplies, technicians, and facility, but not the interpretation of the service.

    Strictly following these modifier guidelines is essential to your bottom line, because reimbursement will be higher when a code is billed globally than when it's billed with modifier 26 or TC appended to it. Many specialties have codes that can be billed according to these guidelines, including the following:

    Radiology: Most radiology codes, including ultrasounds, x-rays, CT scans, magnetic resonance angiography, and MRIs may be billed with modifier 26 or TC, or with no modifier at all, indicating that the provider performed both the professional and technical services.

    For example, an orthopedic surgeon sees a patient in his or her office for a broken ankle. The surgeon requests that x-rays of the patient's ankle be taken in his office. The surgeon would bill 73600, radiologic examination, two views.

    Because no modifiers are appended to the code, the surgeon is indicating to the third-party payer that he or she performed both the technical component and the reading and interpretation of the x-rays for this patient.

    If the x-ray were taken elsewhere, such as in a hospital, the hospital would bill the code 73600-TC, indicating that the hospital is billing only for the technical component. The radiologist at the hospital who read the x-ray would also bill the code 73600-26, indicating that he or she read and interpreted the x-ray and wrote a report concerning his or her findings.

    Pathology: A pathologist may perform a gross and microscopic examination of an ovary, code 88305, during a surgery in a hospital. Under the circumstance that this pathologist bills independently, the hospital would bill the technical component 88305-TC, and the pathologist would bill for just services using the code 88305-26, billing for just the interpretation and the pathology report.

    Obstetrics: A prime example of an obstetric code that may require modifiers is 59025, a fetal nonstress test. If the provider only does the interpretation and writes a report of the results of the test, he or she would bill the service as 59025-26, fetal nonstress test, interpretation and report only.

    This probably would occur if the test is performed in the hospital, either inpatient or outpatient, and the hospital bills 59025-TC, indicating that it is billing only for the technical component. However, when the provider renders both the interpretation and the technical part of the service, usually in the provider's office, the fetal nonstress test would not need any modifiers and be billed just as 59025.

    Cardiology: An example of the use of the modifiers 26 and TC when billing a cardiology code would be 93303, transthoracic echocardiography for congenital cardiac anomalies, complete. In this case, the provider would bill this code with a modifier 26, 93303-26, specifying that the only services that he or she provided were the interpretation and the report. The technical portion would be billed by the hospital as 93303-TC.

    Exceptions to the rules
    There are some exceptions to the modifier TC and 26 rules, and the codes that fall under these exceptions should be billed by individual code indicating whether the code is for the professional or technical component or whether the code is a global code. For example, when code 93000, EKG, is used, this explains that the provider rendered the service of a routine EKG with at least 12 leads with interpretation and report.

    For example, if Mrs. Smith sees her cardiologist for a routine visit, and an EKG is done in the office with interpretation and a report by the provider, code 93000 would be billed. However, if the patient has the EKG performed in the outpatient department of a hospital, and the readings are sent to her provider, then the hospital would bill 93005, tracing only without interpretation and report, and the provider would bill 93010, interpretation and report only. Rather than adding a modifier, each situation requires its own unique code.
    ++++++++++++++++++++++++++++++++++++++++++++++++++

    Thank you for your response. I have been looking for resources on how to bill supplies for interventional radiology and your post shed some light to this. However, the provider that I work for insist on billing for supplies since the hospital that he works for bills for supplies used in interventional radiology. Is there any instances when I can bill for supplies used for these types of procedures?

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