Author Topic: ECHO'S IN OFFICE  (Read 4997 times)

TerriTye

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ECHO'S IN OFFICE
« on: March 19, 2014, 09:05:52 AM »
HELP!! We have taken on a new Provider. He is a cardiologist. He has started doing echo's in the office. For some reason, they were being billed as 93306 with a 26 modifier; the TEE as 93318 with 26 modifier. Needless to say, we are getting denials. Does anyone know how this is to be billed? Any and all input will be greatly appreciated. Thanks!

Michele

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Re: ECHO'S IN OFFICE
« Reply #1 on: March 19, 2014, 11:02:24 AM »
There is no way to give you help without knowing more information.  What kind of denials are you receiving??
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HeidiK

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Re: ECHO'S IN OFFICE
« Reply #2 on: March 19, 2014, 09:26:29 PM »
Hi! 

By googling modifier -26 I was able to confirm this code is used when billing for the professional component only.  Typically, cardiologists will add this modifier to ECHO's performed in the hospital or out-patient facility.  This allows the hospital to submit their claims with a modifier -TC for the technical component.

If he is providing the service in his own office and the practice owns the equipment, there is no need to add the modifier as he should be billing for the full service. 

If this seems to be related to your situation, offer a copy of the CMS Fact Sheet on this subject and request the billing to be corrected so you are able to resubmit the claims.

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Radiology_FactSheet_ICN907164.pdf

Good Luck!
Heidi Kollmorgen, CCS-P
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com

TerriTye

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Re: ECHO'S IN OFFICE
« Reply #3 on: March 20, 2014, 08:18:46 AM »
As it turns out, the denials were due to a technical error with our software. It was not putting the referring or ordering physicians identifier. Having said that.....I still would like input on the proper way to bill these charges.

He is performing echos in office as well as the hospital.
We are now billing:
Stress test: Observation as 93016, Interp as 93018
Echo: 93306/26, TEE - 93318/26

Am I correct in thinking we should not use the 26 modifiers on Echos done in the office, only on the ones in the hospital?

HeidiK

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Re: ECHO'S IN OFFICE
« Reply #4 on: March 20, 2014, 08:58:29 AM »
Hi Terry!

Yes, you are correct.  If you put the modifier 26 on Echos done in the office, the place of service code (11) won't allow the claim to pass clearinghouse edits.  Modifier 26 for reading and interpretation along with modifier TC for technical component must have a hospital or facility place of service code in order to process.

Completing the claim form is like putting together a puzzle - if the pieces don't fit it won't work!  : )

Hope this helps!

Heidi Kollmorgen, CCS-P
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com

HeidiK

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Re: ECHO'S IN OFFICE
« Reply #5 on: March 20, 2014, 09:11:16 AM »
Hello again!

I wanted to add one more thought...  Be sure to confirm with the doctor how you are applying the modifiers, especially if you are not required to perform coding for this client.  They should be submitting the information correctly coded and ready to go for you.

The payment for the Echos done in the hospital setting billed with -26 will be paid at a lesser amount than in the office.  This is one of the main reasons for being able to split the billing between reading/interp only vs. technical component.  The hospital will receive the portion of payment related to the equipment.  Any Echos done in the office will be paid at the full allowed amount.

Radiology billing is similar to this topic as well.

Heidi Kollmorgen, CCS-P
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com

TerriTye

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Re: ECHO'S IN OFFICE
« Reply #6 on: March 22, 2014, 09:39:44 AM »
Example of one of my problems:

I have a fee ticket and the only thing marked is:
93307GS - ECHO 2D MODE
93320GS - DOPPLER ECHO
93325GS - COLOR FLOW

Now.....do I need an office cpt as well? Ex: 99214/25 or do I only bill the echo codes. It lists the GS with the CPT - do I use that or leave it off? (this is done in office)
Again, have never done cardio billing and learning as I go, so any info is greatly appreciated.

Thanks in advance!

Merry

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Re: ECHO'S IN OFFICE
« Reply #7 on: March 22, 2014, 10:02:16 AM »
Was anything else done for this patient that would necessitate billing an E/M code other than the procedures performed?  Are you questioning whether you should go back to the provider and ask about the office visit or ste you asking if you should add it?

Merry

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Re: ECHO'S IN OFFICE
« Reply #8 on: March 22, 2014, 10:11:29 AM »
Confused about using the GS modifier.
I am not a coder but was curious so looked it up.

GS modifier
Description:
Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level

Guidelines/Instructions:
This modifier may be submitted with the following HCPCS codes:
J0881 through J0882
J0885 through J0886
Q4081

HeidiK

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Re: ECHO'S IN OFFICE
« Reply #9 on: March 22, 2014, 10:17:03 AM »
Some offices will perform an Echo when the patient comes in with symptoms necessitating the test.  In those cases, yes an E/M should be billed.  At other times, the doctor will have the patient schedule a time to come back for the test only and typically doesn't see the patient at that future visit - no E/M would then be billed.  They could bill a 99211 for the technicians time but that is entirely up to the physician to decide and add to the billing form.

I'm not sure why the -GS modifier is listed?  Modifier -GS is described as "Dosage of erythropoietin stimulating agent has been reduced and maintained in response to hematocrit or hemoglobin level" and is used with HCPCS codes J0881-J0882, J0885-J0886 and Q4081. 

There may be something missing here?

Heidi Kollmorgen, CCS-P
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com

TerriTye

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Re: ECHO'S IN OFFICE
« Reply #10 on: April 08, 2014, 01:50:58 PM »
This is what I have learned - For Echo's in the office, We bill 93306 - that bundles the 2d, Doppler and color flow. 93224 is to be billed as 93224, this is a bundle as well.
My next question is this: 93744 - Dual Chamber wReprogramming. Is this an accurate procedure code. It is marked on my fee ticket; but I cannot find any info on this. I also have a 93743 - which is "wo Reprogramming". Does anyone have any experience with billing these codes?

HeidiK

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Re: ECHO'S IN OFFICE
« Reply #11 on: April 08, 2014, 02:28:00 PM »
Hi Terry!

I would suggest speaking with the office to get more clarification of how they want these procedures (with modifiers or not) filed on  insurance claims.  Without the medical record explaining the entire circumstance, it's difficult to offer proper advice.

There were a significant number of changes to cardiology CPT codes in 2009, and 93744 was deleted as well as 93743.  My suggestion would be for this cardiology practice to have their entire fee schedule reviewed.  If they have continued to bill these two codes for the last four years, they may have lost a significant amount of reimbursement and chances are high other revisions are necessary to improve their revenue cycle.

I mentioned in a previous reply how I wasn't sure if you were responsible for coding or billing only.  If you are a coder, I'm sure you are aware of the difficulties in cardiology coding and more recent years have had numerous changes also.  If you are responsible for a fee schedule review as part of your services, I would suggest doing so immediately.  If you need help providing this additional service for your client, let me know if I can be of any further help!  :)
Heidi Kollmorgen, CCS-P
AHIMA Approved ICD-10 Trainer
hdmedicalcoding.com