Medical Billing Forum
Coding => Coding => : kalozie August 24, 2009, 11:23:17 AM
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Our cardiologist supervises the SPECT studies in a hospital settiing, a different cardiologist is iterpreting and doing the report at a later time. We have been billing 78465-26,78478-26,78480-26, 93016. Some of our payers have been rejecting the claim b/c another provider performed part of the service. Should we also be using the 52 modifier for reduced services? Any insight on the correct coding of this would be appreciated.
Kim
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wow, u are everywhere ;D
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wow, u are everywhere ;D
I only asked this question on this forum and one other....I ask on two sites b/c sometimes you don't get replies.
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Hi,
I'm not familiar with this situation but, you stated that "Our cardiologist supervises the SPECT studies in a hospital settiing" To me, that doesn't sound like they are doing what the 26 modifier describes. The 26 modifier indicates the professional component, reading the test. It sounds like your cardiologist is just overseeing the test to make sure it is performed correctly, right? If so, that would be included in the TC portion of the billing.
Let me know if I missed it.
Thanks
Michele
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Hi,
I'm not familiar with this situation but, you stated that "Our cardiologist supervises the SPECT studies in a hospital settiing" To me, that doesn't sound like they are doing what the 26 modifier describes. The 26 modifier indicates the professional component, reading the test. It sounds like your cardiologist is just overseeing the test to make sure it is performed correctly, right? If so, that would be included in the TC portion of the billing.
Let me know if I missed it.
Thanks
Michele
Hi Michelle,
Thanks for your reply. I guess what confuses me is the Nuclear Tests are more extensive and it seems the physician should receive a higher reimbursement a Nuclear study than a standard stress test which would also be coded 93016. I have documentation from the AAPC Medical Coding site that says :"To report physician supervisionand/or interpretation only of a cardiovascular stress test performed using institution -owned equipment, use codes 93016 or 93018 (in conjunction with the codes for the diagnostic procedure, e.g. 78465).
I had also read on another site at one point that if one physician supervises and another reads the report at a later time, both should bill using the modifier for reduced services. So it appears there is a varieny of opinions on this and it is leaving me scratching my head, needing an definitive answer. Don't want an audit!!!!! :}