Author Topic: Radiology billing R0075 with use of modifiers?  (Read 2908 times)

Meli

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  • Melissa Turner
    • Mainstream Services Inc.
Radiology billing R0075 with use of modifiers?
« on: April 22, 2010, 03:36:16 PM »
Hi all,

I recently started billing for a radiology office that travels to different clinics/offices to perform ultrasounds.  Generally the transportation code used has bee R0075 with a modifier however I received a patient bill today with the UN modifier listed.   This is for a Medicaid patient and I am concerned about the inconsistent use (non-use)  of the modifier across the board for patients seen.  (Medicaid and commercial insurance).  Although I understand aspects of coding I require my clients to provide the codes as they provided the services.  Should the modifiers be used always with R0075?  Below is some detail.


R0075 must be billed in conjunction with the CPT radiology codes (7000 series) and only
when the x-ray equipment used was actually transported to the location where the x-ray
was taken. R0075 would not apply to the x-ray equipment stored in the location where
the x-ray was done (e.g., a nursing home) for use as needed.

Below are the definitions for each modifier that must be reported with R0075. Only one
of these five modifiers shall be reported with R0075. NOTE: If only one patient is
served, R0070 should be reported with no modifier since the descriptor for this code
reflects only one patient seen.

UN - Two patients served
UP - Three patients served
UQ - Four patients served
UR - Five Patients served
US - Six or more patients served

Payment for the above modifiers must be consistent with the definition of the modifiers.
Therefore, for R0075 reported with modifiers, -UN, -UP, -UQ, and ľUR, the total
payment for the service shall be divided by 2, 3, 4, and 5 respectively. For modifier ľUS,
the total payment for the service shall be divided by 6 regardless of the number of
patients served. For example, if 8 patients were served, R0075 would be reported with
modifier ľUS and the total payment for this service would be divided by 6.

Thanks,

Melissa Turner, CPMB
Mainstream Services Inc.
www.msmbinc.com

blhoffman

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Re: Radiology billing R0075 with use of modifiers?
« Reply #1 on: April 23, 2010, 09:55:59 AM »
Hi Mainstream,

I'm in PA so I checked with Medicare, PA Medicaid and several of our commercial insurances and they all say the same thing.

Code R0070 - no modifier because it is only for one patient.
Code R0075 - must use one of the five modifiers you have listed. If the modifier is absent then the claims  will be denied.

You cannot bill R0070 and R0075 on the same claim.

To answer your question, I believe that you should always bill the modifier when using code R0075.

Hope this helps.
Brenda

Meli

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  • Melissa Turner
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Re: Radiology billing R0075 with use of modifiers?
« Reply #2 on: April 23, 2010, 10:36:32 PM »
Thanks Brenda.  I agree.  Sometimes need the second (and third and fourth) opinion.   ;D
Melissa Turner, CPMB
Mainstream Services Inc.
www.msmbinc.com

Pay_My_Claims

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Re: Radiology billing R0075 with use of modifiers?
« Reply #3 on: April 23, 2010, 10:50:18 PM »
lol and we do!!

Meli

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  • Melissa Turner
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Re: Radiology billing R0075 with use of modifiers?
« Reply #4 on: April 26, 2010, 11:57:41 AM »
OK guys, one more question for this.  (and I'm sorry but I probably should have posted this under the coding section)  :(

When you bill using R0075 the insurance carrier does not matter when looking for the correct modifier.  Meaning, all patients seen at each clinic regardless of carrier determines the modifier. 

Billing modifiers pertaining to the number of patients seen per insurance is incorrect right?   ???

Ex: 2 BCBS and 1 Medicaid does not negate the fact that 3 patients were seen on the same day at the same clinic and modifier UP should be used.  Not UN for the 2 BCBS and then R0070 for the 1 Medicaid patient.

I don't code for my clients however I do analyze and review the information provided so we are billing correctly and this just stands out to me as an error.

Melissa Turner, CPMB
Mainstream Services Inc.
www.msmbinc.com

blhoffman

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Re: Radiology billing R0075 with use of modifiers?
« Reply #5 on: April 26, 2010, 12:57:33 PM »
Hi,

I found this information. I hope it is helpful. I plan to research a little more. This is a very good question. :)

Medicaid prorates the transportation reimbursement according to the number of Medicaid members served at the location. Do not include non-Medicaid members when determining the appropriate modifier to use with procedure code R0075. For example, if the provider provides X-ray services to five nursing home residents and only two are Medicaid members, the provider would indicate modifier "UN." A sample claim for portable X-ray services is available.