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Interpretation and Report question

  1. #1
    Default Interpretation and Report question
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    I work for an Internal Medicine practice. We perform ultrasounds here in the office, but a Cardiologist reads and interprets the reports. We do not have a problem getting paid for the technical component, however....the Cardiologist is being told his claims are being denied by his billing dept. I'm not sure how they are billing the claims except they know to append the 26 modifier. Can anyone give me any suggestions as to what they are possibly doing wrong? I just want to help them out. Is the Cardiologist's billing dept. supposed to use the dos the u/s was performed here in this office or the date the report was dictated? Is the dx code used to order the procedure the same dx code used to bill for the interpretation and report? or should they be using the dx from the interpretation? Any advice would be helpful!

  2. #2
    Salt Lake City
    Why are you not billing it globally without any modifier? And is it possible a Radiologist is doing a reading as well?
    Jenifer McPolin CPC, CPMA, RCC

  3. #3
    We are not billing it globally b/c our outpatient office is used to perform the u/s, a Cardiologist reads and interprets the Echo 2D and Carotid Doppler procedures. We bill out the u/s with a TC mod, the Cardiologist's office bills out the u/s with a 26 mod. It wouldn't be appropriate to bill out the u/s globally.

  4. #4
    The Cardiologist is not a member of our group, maybe that is why you were wondering why we are not billing these out globally.

  5. #5
    Salt Lake City
    Ok I gotcha, I am wondering if the office that is doing the ultrasound is having it also sent to a radiologist to read have you talked to the insurance company?
    Jenifer McPolin CPC, CPMA, RCC

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