Don’t Append Modifier 26 When You Performed the Global Service
Question: A cardiology practice performs an echocardiogram on a patient with chronic diastolic (congestive) heart failure. The practice owns the equipment, employs the technician, performs the test, and has its cardiologist interpret the study and complete the report. I’ll report 93306-26 for the procedure, but would appending modifier 26 be appropriate here to identify the cardiologist’s interpretation? New Jersey Subscriber Answer: Modifier 26 (Professional component) identifies the professional component when the physician provides the professional portion of a service separately from the technical component. When the same practice performs both the technical and professional components, the coder should generally report the global service without modifier 26. The Centers for Medicare & Medicaid Services (CMS) explains that reporting a code without a modifier represents both the professional and technical components when the code supports the split. In this example, the practice performed the complete service, so the appropriate coding would generally be 93306 (Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography) with I50.32 (Chronic diastolic (congestive) heart failure) appended. The incorrect 93306-26 could trigger an audit or payment review because the modifier tells the payer that the practice provided only the professional component, even though the documentation shows that the practice also provided the technical component. CMS has specifically identified incorrect use of modifiers 26 and TC (Technical component) as a source of Medicare overpayments. Before you append modifier 26 or TC, determine who performed each component of the service. If your practice performed both the technical and professional components, report the global service when the CPT® code and payer rules permit it. Suzanne Burmeister, BA, MPhil, Medical Writer and Editor
