Pathology/Lab Coding Alert

Hint: These modifiers can’t separate every lab service.

When your pathologist interprets a lab test, you might automatically reach for modifier 26 (Professional component). However, the use of this modifier is more complicated than you think when it comes to laboratory services.

Check out these five tips to help you determine when you should apply modifiers 26 or TC (Technical component …) to your laboratory services, and when you should refrain.

1. Distinguish Technical and Professional Component Codes

Many codes for pathology services that are paid through the 2024 Medicare Physician Fee Schedule (MPFS) describe a “global” service that includes both technical and professional components. The entire global service should be billed by a provider who owns the equipment, performs the service, and interprets the results.

Example: The global codes include surgical pathology procedures such as 88104 (Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation).

In cases like this, you can append modifiers 26 or TC to tell insurers that you didn’t perform both parts of the service, but that you instead only performed the professional interpretation (26) or the performance of the test itself (TC).

Tip: For Medicare payers, you can pinpoint codes with separate technical and professional components by consulting the Medicare Physician Fee Schedule search tool on the Centers for Medicare and Medicaid Services (CMS) website at https://www.cms.gov/medicare/physician-fee-schedule/search.

2. Break Out Global Components

The most straightforward use of modifiers 26 and TC occurs when you’re aiming to report the component of a global code that you performed when a separate entity performed the other component.

TC: TC is a HCPCS Level II modifier, which covers the provision of all equipment, supplies, personnel, and costs related to performing the procedure. For instance, if your lab prepares special stain slides for a pathologist who is not part of your lab, you should bill the code with modifier TC. When you report the technical component, your lab will get paid for the equipment, supplies, and staff involved in preparing the special stain slides.

26: This is a CPT^® modifier that describes a physician’s professional services that aid in determining a medical diagnosis when a separate entity performed the technical service. For instance, in the prior example, the pathologist who interpreted the special stain slides would bill the same code with modifier 26.

In other words: The technical component includes the supplies, equipment, and technician labor involved in doing the procedure, such as preparing slides, while the professional component generally represents the physician’s evaluation and interpretation.

3. Understand Payment Differences

If you bill both the technical and professional components of a particular code, you’ll collect the global fee that’s reflected in the 2024 MPFS database. However, that database will also show what you’d collect if you reported the code with modifier 26 or modifier TC appended.

For example: Suppose you bill Medicare for a methenamine silver test to evaluate for fungal organisms. If you bill the global code 88312 (Special stain including interpretation and report; Group I for microorganisms (eg, acid fast, methenamine silver)) on its own, or you append the TC or 26 modifiers, your payment amounts will be different. The following are non-facility fees from the 2024 MPFS, not adjusted for geographic pay differences: