Using Modifier 26 with CPT Add-on Codes

[jrwood]

I have a question on using modifier 26 with cpt add-on codes 77001 and 77002. Our practice management software is stating that we need to add modifier 26 for the professional component of the cpt. However, our physician is arguing that we are not suppose to use modifier 26 with add-on codes. Does anyone have any information that they can share on the usage of modifier 26 on add-on codes?

[AnthonyBush]

Fluoroscopic guidance can be used independently or in combination with other imaging methods; therefore, it is important to refer to the code descriptors, parenthetical instructions, and introductory notes for specific reporting instruction. For example, fluoroscopic guidance (77002) is inclusive of all radiographic arthrography with the exception of supervision and interpretation for computed tomography and magnetic resonance arthrography. Therefore, it is not appropriate to report 77002 in addition to codes 70332, 73040, 73085, 73115, 73525, 73580, and 73615.
Fluoroscopic guidance is inclusive of organ or anatomic specific radiological supervision and interpretation procedure codes 74320, 74350, 74355, 74445, 74470, 74475, 75809, 75810, 75885, 75887, 75980, 75982, and 75989.

If the physician is not present in the operating room during a procedure that uses fluoroscopy or fluoroscopic guidance, that physician should not submit a code for fluoroscopy because fluoroscopic imaging requires personal supervision. However, the appropriate radiographic code to report the anatomy evaluated should be submitted in the event that (1) the radiologist's contract with the hospital requires that a radiologist issue a formal interpretation or (2) the physician performing the study requests that a radiologist produce a formal report of the procedure from permanent images recorded.

This is from CPT Assistant, February 2007 Page 11

Anthony Bush, CPC, CCP
Medical Records Review Coordinator

[jrwood]

What if the physician is inserting the port access in the office. Would we bill the cpt with a modifier 26? And is modifier 26 appropriate for add-on codes?

[kevbshields]

Ok, I think you have a bit going on here.

-26 may be appended to add-on codes for which there is the TC/26 breakout.

However, if these are being done in the office, I'm wondering if the physician owns his own equipment; I'm also curious as to whether any Radiologists are reading the films behind the physician or anything wacky like that.

For all sakes and purposes, -26 and -TC are added (and therefore, broken out) when two different entities (typically) are reporting the same service--think Physician(26) and Hospital(TC). If your physician owns and operates the equipment being used , etc, then it would not be necessary to append these modifiers.

By the way, 77002 is not an add-on.

Hope this helps.

[AnthonyBush]

According to CPT, when reading about code 77001 it is an add on code. In the description of the code it states: "includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic SUPERVISION and INTERPRETATION, and radiographic documentation of final catheter position." According to this you can not use a modifier -26...the supervision and interpretation is inclusive to 77001.

[kevbshields]

Actually, the only radiology code on which you can't append a Mod-26 is 76140.

It is acceptable under the appropriate circumstances to append -26 to everything else out of Radiology (and some other areas of CPT).

Hope this makes sense.

[irene quast]

Our state Medicaid program fee schedule breaks out code 77001 with the global code, the code with -TC modifier and the code with -26. I would certainly check with your payers and verify how they want your services submitted.