Gastroenterology Coding Alert

Question: I-m new to coding, and I-m wondering what gastroenterology codes have the modifier 26/TC components. How do I find out?


South Carolina Subscriber
Answer: In a gastroenterology practice, the codes you-ll most commonly apply that contain a professional (modifier 26) and technical (modifier TC) component appear in CPT's -Medicine- section. Specifically, gastro testing codes 91000-91065, 91110-91122 and 91132-91299 all contain both technical and professional components.

Other procedures you might bill in a gastroenterology practice that include both professional and technical components are fluoroscopic guidance services, such as 74360 (Intraluminal dilation of strictures and/or obstructions [e.g., esophagus], radiological supervision and interpretation) and others.

CPT's Appendix A (-Modifiers-) explains that some procedures are a combination of a technical component and a physician (or professional) component. If the far left-hand column of the CMS Physician Fee Schedule database lists separate values for the code with modifiers 26 and TC, modifier 26 is appropriate if the physician provides only the service's professional component.

Tip: The Physician Fee Schedule, updated annually, is available as a free download at the CMS Web site http://cms.hhs.gov/physicians/pfs/.