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ECHO'S IN OFFICE

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TerriTye:
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:
There is no way to give you help without knowing more information.  What kind of denials are you receiving??

HeidiK:
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

TerriTye:
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:
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

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