Forum - Questions & Answers

Jul 7th, 2014 - smoore0808

93351 and hospital setting

I have a question about 93351 in a hospital setting. In some of my data there is a OPPS fee schedule for 93351 for facility but in other places it states that 93351 can be used only in a non facility setting (because of the physician supervision?). If a patient comes in and has a 93351 in a department of the hospital can the hospital also charge for the 93351-TC or is there something else we should be billing on the hospital side versus the physician side?
Thank you,

Jul 8th, 2014 - LBAROGIANIS 250 

re: 93351 and hospital setting

It appears you can bill that code in the hospital with tc modifier, but in my region it has an lcd attach to it. I would get to know your local Medicare contractor, their websites have a wealth of information. The lcd describes in detail what ICD9's that is needed to support medically necessary and what documentation is needed. Good luck!

Jul 8th, 2014 - CodapediaMsgBoard 96 

re: 93351 and hospital setting

If the provider is only providing the professional component (i.e., does not own the equipment), then it would bill with modifier 26. The fee schedule provides technical and professional component modifiers for it.

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