tci Outpatient Facility Coding Alert - 2015 Issue 5
Reader's Question: Go Ahead and Bill EEG With Hospital Visit
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Article Overview
This reader Q&A discusses how a physician’s EEG interpretation can relate to a hospital visit under Medicare billing rules. It focuses on general claims-processing issues in a facility setting, including NCCI bundling concepts, place-of-service considerations, facility payment structure, and use of a professional-component modifier. The article is aimed at coders, billers, and physicians who need to understand when a diagnostic test reading may be reported separately from hospital care.
Why This Topic Matters
It helps providers and coding staff understand why a claim for a diagnostic test interpretation may be denied in a hospital setting and what broad billing context applies to the service.
What You Will Learn
- How Medicare may treat diagnostic testing performed in a facility setting
- How hospital care evaluation and management services relate to diagnostic test interpretation
- Why facility payment structure matters for separate reporting of professional services
- Which general billing concepts are discussed for avoiding claim denials
Who Should Read This
- Medical coders
- Medical billers
- Physicians
- Revenue cycle staff
Modifiers Discussed
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