emg professional and technical

[jsaul]

I was recently approached by a doctor's office to do emgs/ncvs there. They said they would bill the technical and i could bill the professional and keep that.

First I didn't realize there was a technical and professional component to emg/ncv billing. I thought there was only professional fees.

For those that know how much is the medicare professional and technical components for standard emg/ncv cpt codes eg 95900 95904 etc

thanks

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[PMR 4 MSK]

Be careful with this arrangement. Who owns the machine? They bill the technical component.

Will you pay rent there? If not, it can be viewed as a kickback - anti-Stark.

What about insurances that don't separate TC and PC? Many do not.

When our office looked into doing this a couple years ago, the best way was we do the EMG, bill the PC and TC, and pay fair market value rent +/- expenses to the other doctor's office. The other doc wanted a 50-50 split, which is almost certainly anti-Stark. She ended up contracting with someone else who didn't care about the government regs.

 

[RUOkie]

I was recently approached by a doctor's office to do emgs/ncvs there. They said they would bill the technical and i could bill the professional and keep that.

First I didn't realize there was a technical and professional component to emg/ncv billing. I thought there was only professional fees.

For those that know how much is the medicare professional and technical components for standard emg/ncv cpt codes eg 95900 95904 etc

thanks

look up the fee schedule for your region on your FI's website. Look for the -26 reimbursement.

 

[jsaul]

Be careful with this arrangement. Who owns the machine? They bill the technical component.

Will you pay rent there? If not, it can be viewed as a kickback - anti-Stark.

What about insurances that don't separate TC and PC? Many do not.

When our office looked into doing this a couple years ago, the best way was we do the EMG, bill the PC and TC, and pay fair market value rent +/- expenses to the other doctor's office. The other doc wanted a 50-50 split, which is almost certainly anti-Stark. She ended up contracting with someone else who didn't care about the government regs.

I own the machine. Do you know what approx what the TC and PC are typical emg/ncv. If the TC is 20 and the PC is 20 for 95900 then it is almost like a 50/50 split.

Also I would do my own billing. So I were to bill the PC for an EMGNCV and in youe example where then some insurances may not separate the TC and PC-- then that would only benefit me, right?

 

[jsaul]

look up the fee schedule for your region on your FI's website. Look for the -26 reimbursement.

thanks for your response but I don't know what FI's website is?

 

[PMR 4 MSK]

I own the machine. Do you know what approx what the TC and PC are typical emg/ncv. If the TC is 20 and the PC is 20 for 95900 then it is almost like a 50/50 split.

Also I would do my own billing. So I were to bill the PC for an EMGNCV and in youe example where then some insurances may not separate the TC and PC-- then that would only benefit me, right?

Check Medicare tables. It is often around a 60-40 split for TC - PC.

Also if you are billing separately, make sure the testing is pre certified when necessary. I've lost a lot of money over the years getting boned on this. EOB comes in saying "Not authorized, member does not owe." You don't get paid.

Finally, make sure you follow AANEM guidelines, as CMS and many insurance companies follow them for payment.

 

[RUOkie]

thanks for your response but I don't know what FI's website is?

fiscal intermediary. ie: Cahaba, Noridian, Trailblazers etc. Every region has their own FI who you send your bills to. They process your Medicare claims. Find their website, and look at the fee schedule.

 

[PhysiatristDoc]

http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup/index.html

 

[jsaul]

http://cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup/index.html

thank you

 

[jsaul]

Check Medicare tables. It is often around a 60-40 split for TC - PC.

Also if you are billing separately, make sure the testing is pre certified when necessary. I've lost a lot of money over the years getting boned on this. EOB comes in saying "Not authorized, member does not owe." You don't get paid.

Finally, make sure you follow AANEM guidelines, as CMS and many insurance companies follow them for payment.

If the TC is about 60 percent then I don't think this deal is any good for me.I will make only 40 percent on the whole test per patient when I provide the emg machine and supplies plus the testing itself. whereas the practice giving me this opportunity makes 60 percent??

any other sort of arrangement that others have worked out? By the way this practice states they order on average 20 per month

 

[RUOkie]

If the TC is about 60 percent then I don't think this deal is any good for me.I will make only 40 percent on the whole test per patient when I provide the emg machine and supplies plus the testing itself. whereas the practice giving me this opportunity makes 60 percent??

any other sort of arrangement that others have worked out? By the way this practice states they order on average 20 per month

If they are getting the facility fee, they should be providing the equipment and machine.

I do that for inpatient EMGs at our hospital. On the flip side, I do occasional EMGs for a local LTAC. I bring my machine, and they reimburse me for the entire facility fee by the medicare fee schedule (since I am providing the equipment)

If you are providing the equipment and supplies, PAY RENT!!. Pay a few hundred a month for an exam room. I have done that in the past. You are overpaying for the rent, but 20 EMGs more than makes up for that.

Whatever you do, don't allow a "per click" arrangement (where you get paid $x.xx per patient). That is a violation of the kickback rule and can put you in jail.

 

[Jitter Bug]

You have to weight the money against picking up 20 EMG referrals a month.

If you are bringing in your own machine, then I would ask them to calculate a schedule for rent and the use of their receptionist/insurance pre-auth/room turnover/pt scheduling/report filing.

That way you can bill out the whole procedure but pay them for what they are doing for you. Hopefully you can come up with arrangement that is fair for both of you.

 

[PMR 4 MSK]

If you bring the machine and do the test, you should only be paying rent. Anything else will be considered a kickback.

One idea I have played with is renting my machine out to people, i do the EMG, then letting them bill TC. Our lawyers still don't like that arrangement.

 

[PhysiatristDoc]

or they can rent you/your corporation by the hour and give you a 1099.

that's the best option because you can demand a min # of hours and set up how many limbs/hour you are willing to do.

 

[jsaul]

or they can rent you/your corporation by the hour and give you a 1099.

that's the best option because you can demand a min # of hours and set up how many limbs/hour you are willing to do.

in this case they would do all the billing themselves and keep everything themselves?

 

[jsaul]

another thing is that the doctor's office in question here states that I could bill a consult as well as the professional services for emg ncv. I have never billed a consult code along with emg ncv codes before. can this be done? I think I have seen other docs do this because when I see emg reports I see a HPI PE and assessment and reccs. the assessment was the conclusion from the emg and the reccs were something like reccomend MRI or reccomend surgical eval or reccomend CTS splints

 

[RUOkie]

another thing is that the doctor's office in question here states that I could bill a consult as well as the professional services for emg ncv. I have never billed a consult code along with emg ncv codes before. can this be done? I think I have seen other docs do this because when I see emg reports I see a HPI PE and assessment and reccs. the assessment was the conclusion from the emg and the reccs were something like reccomend MRI or reccomend surgical eval or reccomend CTS splints

I will do this when a referral source specifically requests a consult. Usually they want me to do management after the EMG (like for neuropathies, CTS injections, etc.) You need to use a separate ICD-9 code for the E&M code and for the EMG.

If every EMG at a location has a consult attached to it, you are inviting a Medicare billing audit.

 

[jsaul]

another thing is that the doctor's office in question here states that I could bill a consult as well as the professional services for emg ncv. I have never billed a consult code along with emg ncv codes before. can this be done? I think I have seen other docs do this because when I see emg reports I see a HPI PE and assessment and reccs. the assessment was the conclusion from the emg and the reccs were something like reccomend MRI or reccomend surgical eval or reccomend CTS splints

 

[PMR 4 MSK]

another thing is that the doctor's office in question here states that I could bill a consult as well as the professional services for emg ncv. I have never billed a consult code along with emg ncv codes before. can this be done? I think I have seen other docs do this because when I see emg reports I see a HPI PE and assessment and reccs. the assessment was the conclusion from the emg and the reccs were something like reccomend MRI or reccomend surgical eval or reccomend CTS splints

Only if you do something district from the EMG.

If you dx CTS and say "I recommend nighttime bracing and an NSAID" that is not enough to warrant E&M.

If, however, you see a Pt with weird weakness and numbness, and the EMG does not tell the full story, you can do a separate E&M , especially if you will be following up with the Pt.

 

[bedrock]

Only if you do something district from the EMG.

If you dx CTS and say "I recommend nighttime bracing and an NSAID" that is not enough to warrant E&M.

If, however, you see a Pt with weird weakness and numbness, and the EMG does not tell the full story, you can do a separate E&M , especially if you will be following up with the Pt.

I think that's legal. I see it all the time. If you do the first step in treatment instead of the referring MD, you've eliminated one office visit the patient would have anyway, so if they are seen again for this problem, that doc can move on to the next step.

Wouldn't bill more than a level 3 though.

Personally I never bill a consult, but I don't fault those that do.

 

[RUOkie]

I think that's legal. I see it all the time. If you do the first step in treatment instead of the referring MD, you've eliminated one office visit the patient would have anyway, so if they are seen again for this problem, that doc can move on to the next step.

Wouldn't bill more than a level 3 though.

Personally I never bill a consult, but I don't fault those that do.

Legal and Inviting trouble are two different things. One of the thingss that most coding experts recomend is to not be greedy. If your standard codes are exceeding the average, you are asking for an audit.

Most Medicare audits are determined through claims analysis. So if every time you bill a 95900, there are 8 units, you are asking for trouble. So does excessive use of the -25 modifier. It is OK to use occassionally, but if used at every visit, you ask for trouble.

Just like the patient with shoulder pain who has persistent pain after 3 weeks of PT. You do an injection. Do you bill the E&M code as well? I don't. But if a patient has not been seen in 2 years, and after taking my H&P decide to inject the patient, I do bill the E&M.

 

[PMR 4 MSK]

Legal and Inviting trouble are two different things. One of the thingss that most coding experts recomend is to not be greedy. If your standard codes are exceeding the average, you are asking for an audit.

Most Medicare audits are determined through claims analysis. So if every time you bill a 95900, there are 8 units, you are asking for trouble. So does excessive use of the -25 modifier. It is OK to use occassionally, but if used at every visit, you ask for trouble.

Just like the patient with shoulder pain who has persistent pain after 3 weeks of PT. You do an injection. Do you bill the E&M code as well? I don't. But if a patient has not been seen in 2 years, and after taking my H&P decide to inject the patient, I do bill the E&M.

Even with that last example, CMS considers E&M codes bundled, unless you treated something else at the same time, like injected the shoulder, but wrote for PT and an NSAID for the knee.

 

[RUOkie]

Even with that last example, CMS considers E&M codes bundled, unless you treated something else at the same time, like injected the shoulder, but wrote for PT and an NSAID for the knee.

sorry, I should have been clearer. You are correct.