Imaging Procedure Pricing calculation
Imaging Procedure Pricing for Multiple Procedure Reduction and OPPS Cap Worksheet Example1. Look up the TC of the procedure on the Medicare Fee Schedule on TrailBlazer’s Web site at:...
View ArticleRadiology claim billed as global claim
Global BillingGlobal billing is when the physician/practitioner bills for both the TC and PC of a test. The physician/practitioner may bill globally when he performs the test and interpretation. The...
View ArticleRadiology claim when service in inpatient or outpatient hospital setup
Services Provided in Inpatient or Outpatient HospitalAs a reminder, carriers must pay under the fee schedule for the TC of radiology services furnished to beneficiaries who are not patients of any...
View ArticleBilling radiology claim under arrangements
Under ArrangementsA hospital/provider may have others furnish certain covered items and services to their patients through arrangements under which receipt of payment by the hospital/provider for the...
View ArticleImportant CMS 1500 field for radiology billing
CLAIMS FILING REQUIREMENTSNote: Physicians and suppliers who qualify for an exemption from the mandatory electronic claims submission requirements and who submit claims using the paper claim Form...
View ArticleICD 9 - dx code correct usage in radiology billng
Use of ICD-9-CM to the Greatest Degree of Accuracy and CompletenessThe testing facility or the interpreting physician should code the ICD-9-CM code that provides the highest degree of accuracy and...
View ArticlePayment pricing limitation - When Anti-Markup Applies
Anti-Markup Pricing LimitationAnti-markup applies when a diagnostic service payable under the Medicare Physician Fee Schedule is performed by one physician/supplier and billed by another...
View ArticleMedicare Radiology payment when Anti-Markup Does Not Apply
When Anti-Markup Does Not ApplyThe anti-markup payment limitation will not apply if the performing physician “shares a practice” with the ordering/billing physician or other supplier. There are two...
View ArticleRadilogy claim submission - specific instruction for paper and electronic claims
Specific Instructions for Filing Claims Subject to Anti-Markup LimitationProviders may not submit a global billing or total component code on paper or electronic claims when one component of the...
View ArticleMODIFIERS SPECIFIC TO RADIOLOGY
26 Modifier (Professional Component)When the physician component is reported separately, the 26 modifier must be added to the procedure code. The payment includes the physician’s work, practice expense...
View Article52 Modifier in Radiology billing
52 Modifier (Reduced Services)Procedures for which services performed are significantly less than usual may be billed with the 52 modifier.CPT defines the 52 modifier as “Reduced Services: Under...
View ArticlePHYSICIAN SUPERVISION - General, Direct supervision in Radiology billing
PHYSICIAN SUPERVISIONThe technical component of diagnostic tests for a Medicare beneficiary who is not a hospital inpatient or outpatient (generally services performed in an office setting or...
View ArticleRadiology procedure does not require for physician signature
Physician Signature Requirements for Diagnostic TestsA physician’s signature is not required on orders for clinical diagnostic tests (including X-ray, laboratory and other diagnostic tests) that are...
View ArticleTreating Physician/Practitioner Ordering of Diagnostic Tests
The treating physician/practitioner must order all diagnostic tests furnished to a beneficiary who is not an institutional inpatient or outpatient. A testing facility that furnishes a diagnostic test...
View ArticleDetermining the Appropriate Primary ICD-9-CM Diagnosis Code
Determining the Appropriate Primary ICD-9-CM Diagnosis Code for Diagnostic Tests Ordered Due to Signs and/or SymptomsIf the physician has confirmed a diagnosis based on the results of the diagnostic...
View ArticleInterpreting Physician Exception
This exception applies to an interpreting physician of a testing facility who furnishes a diagnostic test to a beneficiary who is not a hospital inpatient or outpatient. The interpreting physician must...
View ArticleInstruction to Determine the Reason for the Test
As specified in the Balanced Budget Act (BBA), referring physicians are required to provide diagnostic information to the testing entity at the time the test is ordered.On the rare occasion when the...
View ArticleCan we bill Incidental Findings dx code as primary dx code?
Incidental FindingsIncidental findings should never be listed as primary diagnoses. If reported, incidental findings may be reported as secondary diagnoses by the physician interpreting the diagnostic...
View ArticleUnrelated/Coexisting Conditions/Diagnoses in radiology billing
The physician interpreting the diagnostic test may report unrelated and coexisting conditions/diagnoses as additional diagnoses.Example: A patient is referred to a radiologist for a chest X-ray because...
View ArticleEKGs AND X-RAYS PERFORMED IN THE EMERGENCY ROOM
Specialty is not the primary factor considered when payment is made for an interpretation of an EKG or X-ray done in the Emergency Room (ER). Payment will be made for the interpretation and report that...
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