Author Topic: billing 93016 on 1500  (Read 1788 times)

kfrey10

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billing 93016 on 1500
« on: April 02, 2014, 06:09:11 PM »
Hello!
We are a critical access hospital and new to billing nuclear medicine.  We are having to bill 93016 on a 1500 claim form, but the physician that will be doing the supervision is one of our Emergency Room physicians.  We normally bill this physician's services then with our Emergency Physician's Group NPI, but since this isn't going to be anything to do with the ER, do we need to credential him under our normal hospital outpatient NPI that is normally on our UB's?  Any assistance would be appreciated!

RichardP

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Re: billing 93016 on 1500
« Reply #1 on: April 02, 2014, 09:41:34 PM »
He would need to be credentialed under whatever the billing entity will be that will bill for the stress test (assuming that it is the hospital that is administering and billing for the test, and not a physician in private practice using your outpatient facilities).  Since you are new to billing nuclear medicine, here is a good, and concise, overview of stress test coding:

http://codapedia.com/article_233_Stress-test-coding.cfm

It was my understanding that hospital billing, regardless of inpatient or outpatient, has to be on the UB-04 Form.  But I don't do hospital billing - so maybe my understanding is incomplete?

If you are actually talking about a physician in private practice who is using your outpatient facilities, and has hired this doctor to supervise the tests, then we are talking about an animal with different stripes.  See the following link.  Note that the post is talking only about billing Medicare.  We do this sort of billing, and our Commercial carriers don't require a Type 1 NPI Number in Box 24J - so the Commercial carriers never know that it wasn't the billing doctor who did the work.

http://www.medicalbillinglive.com/members/index.php?topic=7045.msg21031#msg21031

You might also read through this link for more general information.  If a physician in private practice is not involved in this transaction at all - then nevermind.

http://www.medicalbillinglive.com/members/index.php?topic=7436.msg23215#msg23215
« Last Edit: April 02, 2014, 10:17:02 PM by RichardP »

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Re: billing 93016 on 1500
« Reply #1 on: April 02, 2014, 09:41:34 PM »