General Surgery Coding Alert

If you're not coding your surgeon's portion of the radiological procedures involved in performing a biopsy, you're losing out on deserved reimbursement.

Follow our experts' advice to make sure you don't miss the pay you deserve -- or collect technical component pay that rightly belongs to the facility.

Often while performing a biopsy, the surgeon will use some form of radiological guidance. In those cases, you should separately report the proper code for the radiological guidance for the needle placement, says Lynn Woolard, practice manager for General and Vascular Surgery in Elgin, Ill.

If your surgeon uses radiological imaging during a biopsy, you usually can report the appropriate imaging code, such as 76942 (Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation), 77012 (Computed tomography guidance for needle placement ...), or 77021 (Magnetic resonance guidance for needle placement ...) in addition to the biopsy procedure code. But there is a catch.

You need to append modifier 26 (Professional component) to the radiology code. The modifier indicates your surgeon is interpreting the radiological guidance, but is using the facility's equipment. The facility where your surgeon performs the procedure will report the same radiology code, using modifier TC (Technical component).

Why: Certain CPT codes consist of two components:the technical component (modifier TC) and the professional component (modifier 26). Modifier TC is for the entity that owns the equipment, and modifier 26 is for the professional interpretation, Woolard explains.

"If you own the equipment, then you can bill the global code, without the modifier; but, if you are in a facility setting then you can report only the professional component of the code."

Example: Your surgeon uses ultrasonic imaging guidance when introducing a needle to collect a liver specimen (47000, Biopsy of liver, needle; percutaneous). You'll report the liver biopsy code (47000) and the imaging code (76942-26) for the procedure provided your surgeon dictates and signs the official report for the imaging service.

Warning: If you fail to append modifier 26 and the facility bills the procedure, the technical portion of the service will have been double-billed, says Barbara J. Cobuzzi, MBA, CPC, CENTC, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J., and senior coder and auditor for The Coding Network.

"There may be refunds required if the duplication is not caught prior to payment, and the physician/practice can be indicted for criminal fraud as well as be embroiled in civil fraud proceedings," Cobuzzi adds.

Good news: Many payers, however, will look at your place of service to determine if they should only be paying you the professional component. Plus, Medicare will not pay a physician for the technical component of services provided in a facility setting. In other words, if your claim lists a place of service (POS) as an outpatient hospital (POS 22), forgetting modifier 26 when billing a POS 22 claim won't result in double-billing due to the carrier's autoedit.