Orthopedic Coding Alert

Question: My colleague and I are having a discussion. She says that we need a modifier on all X-ray codes regardless of the situation. I think, however, that there are some instances where you don’t apply a modifier to an X-ray code. Who’s right?

Kansas Subscriber

Answer: You’re right on this one. While many X-ray claims get filed with modifier 26 (Professional component) appended, not all of them require the modifier.

It’s all got to do with ownership of the X-ray equipment. If your physician, or the facility where your physician works, has its own X-ray equipment, you’ll report the code without any modifiers. For example, if the physician conducts a two-view ankle X-ray, you’d report 73600 (Radiologic examination, ankle; 2 views) with no modifier.

If, however, the physician performs the same X-ray using, say, a hospital’s X-ray equipment, you’d report 73600 with modifier 26 (Professional component) appended to indicate that you are only coding for the physician’s work, not the X-ray equipment use. Then, the hospital would report 73600 with modifier TC (Technical component) appended to indicate that it is only coding for the X-ray equipment use, not the physician’s work.

Result: Both the facility and the physician will split the payout for 73600 as both had a hand in providing the service.