May 24th, 2018 - sschwartz 4
I need clarification on when to use CPT 93000. What I am finding is that is the doctor owns the equipment and does the interpretation and report then 93000 is used. Our clinic is owned by a hospital, but there is equipment in the clinic to do the ECG/EKG’s. At times the clinic sends the patient over to the hospital to have the ECG/EKG done; however most of the time it is done at the clinic. When done here at the clinic, some of our providers do the interpretation and report and others do not. My question is, when the test is done here at the clinic and one of our providers does the interp and report as well, do I use 93000? The equipment is the clinic’s, provided by the hospital which owns it and not owned by the Provider himself; but it is at the clinic and the provider belongs to our group, so would it still be 93000 or does the provider actually have to own the equipment as an individual? I had assumed “owned by doctor” was meaning “clinic” too as we were not sending them to another facility to have the test done but one of our techs was thinking the doctor himself had to actually own the equipment; so now I am doubting myself. Would I bill 93010 in this case?
Jun 13th, 2018 - ChrisW 256 1
Very often the additional code information is not considered, be sure to look at each aspect of the code, such as the PC/TC Indicator. 93000 is the complete procedure and includes ECG tracing with physician review, interpretation and report. Use 93005 to report the tracing only, and 93010 to report physician interpretation and written report only.
If you look at the PC/TC Indicator on CPT code 93000, it has a #4 which means this code includes the 26 and TC components. you would not bill 93000 with a modifier, as this code is a global test only code.
It also means there are other codes that describe the PC only and TC portion only of the test, such as:
93005 - tracing only, without interpretation and report. PC/TC indicator # 3 (Technical Component Only Code)
93010 - interpretation and report only. PC/TC Indicator # 2 (Professional Component Only Code).
4 = Global Test Only Codes
This indicator identifies stand-alone codes that describe selected diagnostic tests for which there are associated codes that describe (a) the professional component of the test only, and (b) the technical component of the test only. Modifiers 26 and TC cannot be used with these codes. The total RVUs for global procedure only codes include values for physician work, practice expense, and malpractice expense. The total RVUs for global procedure only codes equals the sum of the total RVUs for the professional and technical components only codes combined.