Neurology & Pain Management Coding Alert

Question: Our provider visits a hospital and actually performs and reads/interprets EMGs and EEGs for both the outpatients and inpatients. The equipment is our equipment, not the hospital’s. The hospital staff does not support these services. Can we bill two line items for each component, one with TC and one with modifier 26? Our provider does both the technical and professional portions of each test. We want to be compensated for our time performing the test. However, Medicare does not pay for the test without modifier 26 when the place of service is 21.

Florida Subscriber

Answer: Medicare and some other payers include the technical component of all diagnostic tests in the facilities payment. These payers will not pay a physician for the technical component whether billed separately with modifier TC or billed as global service without a modifier. You need to check with your payer for modifier 26 (Professional component). One approach can be that you may work with the hospital on creating a payment contract in which the facility reimburses you for the TC (Technical component) portion that they bill. Alternatively, you can appeal the contractor’s denials/policy with an appeals letter providing proof that your provider owns the equipment and brings it to the hospital. But most payers still would not be open to this approach.