LABS:
Let MPFS Status Indicators Show You How To Get Paid
Published on Mon Oct 15, 2007
Harness fee schedule policy rules for the PC/TC modifiers
The Medicare Physician Fee Schedule just shows reimbursement levels for pathologist procedures, right? Wrong. We'll show you how to decipher the MPFS for technical/professional component billing conventions to make sure you get the correct pay--every time.
The MPFS holds the key to payment when you bill for the professional and/or technical components of certain pathology procedures. Two fee-schedule columns provide "payment policy" indicators regarding which services involve professional and/or technical components and how to use modifiers to report the work:
1. PC/TC: The PC/TC (professional component/technical component) indicator column has 10 possible numerals representing the professional or technical service status of each code.
2. Modifier: The modifier column indicates the appropriate modifier to use if the code involves a technical and/or professional component, as indicated in the PC/TC column.
Watch for: The modifier column might be blank, meaning that you should not use a professional or technical modifier with the code. Or the column might list a modifier, indicating that you should report the code with 26 (Professional component) or TC (Technical component), depending on the code and the PC/TC status.
"Because many other payers follow Medicare's lead on clinical test interpretation by pathologists, you should be familiar with Medicare coverage rules," says Dennis Padget, president of DLPadget Enterprises Inc., a pathology business practices company in Simpsonville, KY, publisher of the Pathology Service Coding Handbook.
You should be familiar with the following PC/TC indicators and modifier column entries to obtain proper pay for your pathologist's work, whether for surgical pathology or for a professional opinion regarding clinical lab tests.
PC/TC "0": To specify codes that represent only a physician service, such as clinical laboratory consultation 80500 or 80502, the fee schedule lists a "0" in the PC/TC column.
This corresponds to a blank in the modifier column, meaning you shouldn't append 26 or TC to these codes.
Other codes in this "0" category that pathologists frequently report include physician blood bank codes (86077-86079, Blood bank physician services ...), certain outside slide consults such as 88321 (Consultation and report on referred slides prepared elsewhere) and 88325 (Consultation, comprehensive, with review of records and specimens, with report on referred material), surgical consult 88329 (Pathology consultation during surgery), and bone marrow aspiration and biopsy codes 38220 and 38221 (Bone marrow ...).
PC/TC "1": You'll find a "1" in the PC/TC column for certain diagnostic pathology procedures that have both a professional and technical component paid on the MPFS. Correspondingly, the modifier column indicates you can report the global service (PC and TC) or report each component separately.
For the technical service, the modifier column shows TC. For the professional service, the modifier column lists 26.
Don't miss: For the global service, [...]
