Wisconsin Medical Journal
107 #4
107 #4
Questions and Answers – Radiology and Imaging Guidelines Teleconference
February 20, 2007
Question:
Regarding your slide: Can a Provider bill for the contrast? Procedure code 99070.
I am a technical component biller for an MRI Facility. We use the 99070 and I was putting a TC modifier on it. My reasoning was that the Radiologist (which I do not bill for anyway) had nothing to do with the charge of supplies. But recently an insurance company told me that I was to have no modifier. I explained that having no modifier would represent billing globally. And again, the Radiologist has nothing to do with this charge. Our facility is privately owned and the group of Radiologists bill separately. Now I am confused, should I use a TC modifier or no modifier at all? A side comment is that Medicare does not cover this charge nor do most insurance companies.
Answer:
If the provider incurs a cost for the contrast them he may bill for it. It is important to be sure that no one else is billing this such as a vendor, etc. I would not put a modifier on this. Only one person or provider can bill for the contrast and to append the TC would indicate that there would be 2 providers billing for this supply. You can report the global on this code as it cannot be separated in to professional and technical components. The Medicare Fee Schedule Database is a great resource to check to see if the codes can be split.
I would also check to see if there is a more specific HCPCS code to use. You may be able to use a miscellaneous HCPCS code that the insurance company would approve and pay instead. Check with the vendors of the products or provide the name to us and we will try to assist you in finding the appropriate code, if one exists.
Question:
We have a referring Doctor that orders 70553 for a lot of his patients with hearing problems. This charge represents a MRI of the brain. In addition he charges 70553-52-59 for Inner Auditory Canals. We greatly reduce the charge in comparison to the 70553. We have the 59 modifier showing that it is a separate service from the MRI of the brain. Medicare does pay us for both procedures. Few other insurance companies do reimburse us for both. In fact, they annoyingly pay the reduced IAC charge and deny the main MRI of the brain charge. After your seminar we were wondering if modifier 22 would be more appropriate or if we are even able to bill for both procedures. Your comments would be greatly appreciated.
Answer:
We would ask a couple of questions: 1. How much more work is different with the IAC views? 2. How many additional views are done? 3. Is Medicare requesting documentation or are they just paying these? If there is a large amount of additional work, typically 20-30% then you could possibly append the 22 modifier. As far as Medicare, if they are just paying this you may want to be aware that they could be paying it now but once they review documentation they may discover that this is not supported by the documentation and they may recoup their money.
Question:
I know that you mentioned HCPCS codes for contrast. I admit I know very little about this. We recently started using Q9952 and we charge according to how many units (CC) they use. At first we were just doing this if the patient was obese. Now we charge this code for all contrast patients. As we have to purchase the contrast material. Would this be correct?
Answer:
I would encourage you to contact the vendor to see what HCPCS code they recommend you bill for this. If you will provide the contrast name, etc I will try to find out for sure what the appropriate HCPCS code is for this contrast.
Question:
As an orthopaedic practice, we will perform stress views on a joint (CPT 77071). Are there any documentation recommendations you could share showing how our physicians should document this appropriately? The physicians have the majority of information correct in the note; however, they do not indicate what type of stress and/or how much stress was applied and I would like to educate them on appropriate documentation for this type of service.
Answer:
We could not find anything in any of our resources that stated the best documentation for "stress views". Basically your providers just need to state that there were stress views performed. The radiology CPT codes are broken down by the number of views, not as to stressed vs. non-stressed. Select the code with the most appropriate number of films taken.
Question:
If a patient has an radiology procedure performed one day and the radiologist reads it the next, what day do we report for the radiologists' services? The day the procedure was done or the day of the interpretation?
Answer:
You would report this on the day the provider performed the services. He/she will only be reporting the 26 or the professional component.
Question:
If the patient has an AP knee Standing and comparison views done should we report this with 73565 or 73564 for 4 views?
Answer
You will want to base the CPT code selection upon how many views are done. In this case you would be reporting the CPT code 73564 as there were 4 or more views done.
Question:
Is the code 77073 Bone Studies if physician does this hip to ankle and bilateral can this be billed bilateral?
Answer:
In the Coder's Desk Reference for 2007 it states that this is generally from hip to ankle, states that it does not specify number of films. Due to this fact, if done bilaterally use RT and LT modifier as appropriate.
Question:
MDM – When physician orders x-ray can they get extra points for reading the x-ray? Up to 3 points for ordering and independent visualization?
Answer:
They can get one point for ordering this x-ray. If they are only "reading" and not doing an independent report they cannot get credit for the visualization per an email that we have from WPS Medicare. A physician reading and giving his interpretation or opinion unless is it is a separate report is not an additional point.
Question:
Regarding your slide: Can a Provider bill for the contrast? Procedure code 99070.
I am a technical component biller for an MRI Facility. We use the 99070 and I was putting a TC modifier on it. My reasoning was that the Radiologist (which I do not bill for anyway) had nothing to do with the charge of supplies. But recently an insurance company told me that I was to have no modifier. I explained that having no modifier would represent billing globally. And again, the Radiologist has nothing to do with this charge. Our facility is privately owned and the group of Radiologists bill separately. Now I am confused, should I use a TC modifier or no modifier at all? A side comment is that Medicare does not cover this charge nor do most insurance companies.
Answer:
If the provider incurs a cost for the contrast them he may bill for it. It is important to be sure that no one else is billing this such as a vendor, etc. I would not put a modifier on this. Only one person or provider can bill for the contrast and to append the TC would indicate that there would be 2 providers billing for this supply. You can report the global on this code as it cannot be separated in to professional and technical components. The Medicare Fee Schedule Database is a great resource to check to see if the codes can be split.
I would also check to see if there is a more specific HCPCS code to use. You may be able to use a miscellaneous HCPCS code that the insurance company would approve and pay instead. Check with the vendors of the products or provide the name to us and we will try to assist you in finding the appropriate code, if one exists.
Question:
We have a referring Doctor that orders 70553 for a lot of his patients with hearing problems. This charge represents a MRI of the brain. In addition he charges 70553-52-59 for Inner Auditory Canals. We greatly reduce the charge in comparison to the 70553. We have the 59 modifier showing that it is a separate service from the MRI of the brain. Medicare does pay us for both procedures. Few other insurance companies do reimburse us for both. In fact, they annoyingly pay the reduced IAC charge and deny the main MRI of the brain charge. After your seminar we were wondering if modifier 22 would be more appropriate or if we are even able to bill for both procedures. Your comments would be greatly appreciated.
Answer:
We would ask a couple of questions: 1. How much more work is different with the IAC views? 2. How many additional views are done? 3. Is Medicare requesting documentation or are they just paying these? If there is a large amount of additional work, typically 20-30% then you could possibly append the 22 modifier. As far as Medicare, if they are just paying this you may want to be aware that they could be paying it now but once they review documentation they may discover that this is not supported by the documentation and they may recoup their money.
Question:
I know that you mentioned HCPCS codes for contrast. I admit I know very little about this. We recently started using Q9952 and we charge according to how many units (CC) they use. At first we were just doing this if the patient was obese. Now we charge this code for all contrast patients. As we have to purchase the contrast material. Would this be correct?
Answer:
I would encourage you to contact the vendor to see what HCPCS code they recommend you bill for this. If you will provide the contrast name, etc I will try to find out for sure what the appropriate HCPCS code is for this contrast.
Question:
As an orthopaedic practice, we will perform stress views on a joint (CPT 77071). Are there any documentation recommendations you could share showing how our physicians should document this appropriately? The physicians have the majority of information correct in the note; however, they do not indicate what type of stress and/or how much stress was applied and I would like to educate them on appropriate documentation for this type of service.
Answer:
We could not find anything in any of our resources that stated the best documentation for "stress views". Basically your providers just need to state that there were stress views performed. The radiology CPT codes are broken down by the number of views, not as to stressed vs. non-stressed. Select the code with the most appropriate number of films taken.
Question:
If a patient has an radiology procedure performed one day and the radiologist reads it the next, what day do we report for the radiologists' services? The day the procedure was done or the day of the interpretation?
Answer:
You would report this on the day the provider performed the services. He/she will only be reporting the 26 or the professional component.
Question:
If the patient has an AP knee Standing and comparison views done should we report this with 73565 or 73564 for 4 views?
Answer
You will want to base the CPT code selection upon how many views are done. In this case you would be reporting the CPT code 73564 as there were 4 or more views done.
Question:
Is the code 77073 Bone Studies if physician does this hip to ankle and bilateral can this be billed bilateral?
Answer:
In the Coder's Desk Reference for 2007 it states that this is generally from hip to ankle, states that it does not specify number of films. Due to this fact, if done bilaterally use RT and LT modifier as appropriate.
Question:
MDM – When physician orders x-ray can they get extra points for reading the x-ray? Up to 3 points for ordering and independent visualization?
Answer:
They can get one point for ordering this x-ray. If they are only "reading" and not doing an independent report they cannot get credit for the visualization per an email that we have from WPS Medicare. A physician reading and giving his interpretation or opinion unless is it is a separate report is not an additional point.
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