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Click here for more sample CPC practice exam questions and answers with full rationale

Sleep Study (for Cardio patient) w/Pulmonology interpretation

Cardio meets with patient and gives equipment with direction of use 95800 with Mod -TC
Patient brings back equipment and Cardio downloads report

Pulm picks up report and does interpretation 95800 with Mod -26

But, if Total Recording Time (TRT) is less than 6 hours, Pulm also adds a Mod -52 for reduced services.
The question remains if Cardio needs to add Mod -52 to their charges even if their work was done when handing off equipment.

We cannot find definite answer to this and want to bill correctly.

Medical Billing and Coding Forum

GC Modifier and EKG Interpretation and Report

Hi to all!

When a Resident working in a hospital ED orders a 12 lead EKG and then sends to the strip to be read by the hospital’s Cardiologist,
does the Cardiologist, who is doing the Interpretation and Report without any additional input from the Resident, not add a GC modifier
to the CPT 93010? Or does the GC get added because the Resident produced the EKG strip and will use the report to arrive at the final DX
for the Medicare patient?

Thanks so much for your help!

Brian

Medical Billing and Coding Forum

Same day procedures, different day of interpretation

We have a patient who came to our hospital for same day echo and carotid ultrasound. The technician belatedly placed the carotid ultrasound in the doctor’s box a day after the procedure, thus was read on Day 2. Therefore, we should bill Day 1 93306-26 and Day 2 carotid ultrasound code. Is that correct?
What if there’s a copay associated with it? It’s not the doctor’s fault that it was read on Day 2.

Thanks.

Medical Billing and Coding Forum

Ultrasound without the interpretation report

Hello,
The Dr performed and US but I don’t have the interpretation report. I only have the imaging. I queried the office and they say they only have the imaging. My question is can I bill an US based only in the imaging? Can I bill for the technical component? if so how will that be? Thank you!

Medical Billing and Coding Forum

Supervision and Interpretation for 20611

Hello Awesome Auditors,

Would you please tell me what you are looking for to support the imaging guidance portion of 20611? We recently went through an audit and all of our 20611’s were down coded because the documentation "did not contain appropriate information to support the supervision and interpretation portion of the code."

If the doctor gives information to support why the ultrasound was necessary and states that ultrasound what used, what other documentation are you looking for? He does state the anatomical location he is injecting but does not identify step by step what he sees on the ultrasound. Is that what he needs to do?

Thank you,
Jes

Medical Billing and Coding Forum