Author Topic: Proper outpatient Radiology Claims in the hospital setting  (Read 940 times)

tperian

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Proper outpatient Radiology Claims in the hospital setting
« on: March 25, 2016, 10:28:05 AM »
I am soooo confused about radiology claims done on an outpatient basis in the hospital.  for example:

77057

Do you bill it like this:

77057, no modifier and then on another line 77057,26 

i think this is being done to cover the facility fees and the profession component.  My background is in CMS-1500 so I know that normally the 77057 cover the profession and technical components or you can bill then 77057,TC and 77057, 26.  What am i missing here?  I have a client billing it the way i listed 1st and was told to bill the 77057 and the 77057, 26 on separate claims.  Can somebody please explain the correct way?

 :o :-\ :o :-\


Sriram_Sub

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Re: Proper outpatient Radiology Claims in the hospital setting
« Reply #1 on: March 28, 2016, 04:29:18 AM »
If the facility bills separately for the Technical Component, then the CMS1500 should show up only 77057 with 26 modifier for the professional component. But, if there is no separate billing arrangement between the Technical and professional components, we bill the code without any modifier which will fetch payment for both technical & Prof components.

Ideally, billing 77057 without a modifier on the 1st line and billing the same code with 26 modifier on the 2nd line is NOT correct.

Just to remind you, you may have to make sure you use to right code depending upon the type of mammogram performed. If it was a digital mammogram taken, you bill a G code (G0202-G0206). If it was a Film Mammogram, it would be a 7705x code.

Good Luck.
Sriram

kristin

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Re: Proper outpatient Radiology Claims in the hospital setting
« Reply #2 on: March 28, 2016, 10:26:16 PM »
Agree with Sriram_Sub...to bill on two separate lines with a 26 on one makes it seem like the professional component has been done twice, when that isn't possible, in this scenario. To cover both pro fee and tech fee, you bill on one line with no modifiers.