AANEM News Express

AANEM News Express

Global vs. Technical Billing

2/24/2015
 
If you are a physician who performs electrodiagnostic (EDX) and neuromuscular (NM) testing on patients in a hospital setting, the difference between global and technical billing could be especially relevant to you. Following is an excerpt from the AANEM’s 2015 Coding Guide that addresses this situation:

Our members often ask questions about performing nerve conduction studies (NCS) and needle EMG’s on their patients at a local hospital. If the physician brings their own technician or performs the nerve conduction portion of these tests themselves, would the physician be able to bill the global code and/or the technical component for these studies? The following information has been taken from the AMA’s Resource-Based Relative Value Scale (RBRVS) 2014 Manual, page 107:

“Profession and technical component modifiers were established for some services to distinguish the portion of a service furnished by a physician. The professional component includes the physician work and associated overhead and professional liability insurance (PLI) costs involved in three types of services:
  • Diagnostic tests that involve a physician’s interpretation, such as cardiac stress tests and electroencephalograms;
  • Physician diagnostic and therapeutic radiology services; and
  • Physician pathology services.

The technical component of a service includes the cost of equipment, supplies, technician salaries, PLI, etc. The global charge refers to both components when billed together. For services furnished to hospital outpatients or inpatients, the physician may bill only for the professional component, because the statute requires that payment for nonphysician services provided to hospital patients be paid only to the hospital. This requirement applies even if the service for a hospital patient is performed in a physician’s office.”

Under Medicare policy, physicians cannot bill directly for the technical component of a procedure if performing these services in a hospital setting. The Medicare Diagnostic Related Group (DRG), by law, covers the technical component of Medicare services for inpatients. So, when submitting bills to Medicare, the physician may only submit for and be reimbursed for the professional component of these studies. This rule does not necessarily apply to non-Medicare payers, unless they utilize the DRG policy.

This does NOT mean that physicians cannot reasonably be reimbursed for the part of the technical component to which they are entitled. A physician would have a claim on at least part of the technical component of services performed in the hospital if he/she A) owns the equipment, B) employs the technician who performs the test, or C) personally performs the test. Even if the hospital owns the equipment, if either B or C is true then the physician can bill the institution for part of the technical component. While the physician cannot bill the carrier for the technical component under the DRG system, he/she may either bill the institution or establish a separate contract with them in order to receive the appropriate reimbursement.

For more information such as this, the AANEM 2015 Coding Guide is available for purchase.


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