Otolaryngology Coding Alert

Answer: In the second scenario, your provider will not bill out the CT procedure at all since an outside physician performs and reads the CT elsewhere. The outside diagnostic facility will bill for their services. Your physician can include their review of the CT as a data element of medical decision making (MDM) when the patient comes for a follow-up evaluation and management (E/M) appointment, counting it as independent interpretation of radiological testing.

Note: If the patient receives imaging in-house, the provider can bill the CT without any modifier, assuming that the provider owns the equipment and performs the interpretation.

In the first example, the physician can append modifier TC (Technical component …) to 70486 (Computed tomography, maxillofacial area; without contrast material) on one claim since they own the equipment but did not interpret the report. The interpreting physician will bill out using modifier 26 (Professional component) with code 70486, explaining that the provider only interpreted the report but did not own the equipment. If the TC and 26 modifiers are split between two parties, the party billing for the TC can expect to receive approximately 60 percent reimbursement, while the party billing for the PC will receive the remaining 40 percent.