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Pacemaker Billing when rep is present - 26 modifier only?

  1. #1
    Default Pacemaker Billing when rep is present - 26 modifier only?
    Medical Coding Books
    All,
    We're having a debate in our office regarding billing for pacemaker checks when a company representative is present. I was under the impression we could only bill using a 26 modifier if the rep is present but I'm having trouble backing up that claim with actual resources. My docs want us to bill the global code (no modifier). The physician is not present, only a RN and we do physician based billing. Can someone out there provide me with actual resources regarding billing with a rep present? And/or correct me if I'm wrong?
    Thanks!
    Lara Sanders, CPC

  2. Default
    I work for a cardiologist office (outpatient) and we have device clinics for pacemakers and ICDs. The representatives come in occassionally for any number of reasons and we always bill the global charge for the service. In the past when I have had questions about Pacer/ICD billing, the representatives themselves are EXTREMELY helpful in providing documentation and resources for any questions you may have. I would recommend speaking with any one of them, all of the companies have there own billing departments dedicated solely to assisting offices or hospitals. Hope this helps!

  3. #3
    Location
    Tacoma, WA
    Posts
    1,087
    Default
    Quote Originally Posted by LaraSand00 View Post
    All,
    We're having a debate in our office regarding billing for pacemaker checks when a company representative is present. I was under the impression we could only bill using a 26 modifier if the rep is present but I'm having trouble backing up that claim with actual resources. My docs want us to bill the global code (no modifier). The physician is not present, only a RN and we do physician based billing. Can someone out there provide me with actual resources regarding billing with a rep present? And/or correct me if I'm wrong?
    Thanks!
    Lara Sanders, CPC
    I am not familiar with pacemaker billing, but if the rep was not present, just the nurse would you still be billing for the check? So many visits and procedures require the physician to be present, I am curious what codes you are using. Be careful about what company reps tell you about billing. Often times they are looking for ways to get the services paid, but they don't pay attention to the rules for correct coding and compliance. Always research code for yourself and look for any rules regarding use and who must be present.
    Arlene J. Smith, CPC, CPMA, CEMC, COBGC

  4. #4
    Location
    Fayetteville, NC
    Posts
    300
    Default
    We have a pacemaker clinic twice a year and a company rep comes out and performs the checks. We bill the complete code no modifiers but we own the machinery/equipment and our Doc does the interpretation. The rep basically just performs the tests.
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

  5. #5
    Default
    I agree, if you own your own equipment you should be billing globally but if the rep is utilizing its own equipment to perform the pacemaker checks than you have no choice but to bill with a -26 modifier!

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