Primary Care Coding Alert

Many coding and billing professionals view HCFAs national relative value units (RVU) file as a tool to help determine payment for Medicare-covered services. However, this document is brimming with additional information essential to proper coding about global periods, reporting bilateral and unilateral services, and splitting procedures into technical and professional components.

HCFA updates the RVU file annually and posts it on its Web site. There is a lot of valuable information coders can have right on their desktop, simply by downloading the file, points out Jennifer Butler, billing operations manager with Arizona Medical Provider Services Inc., in Cottonwood, Ariz., which provides billing and management services to physician practices in Arizona.

The RVU file used as the basis for this article can be found on the HCFA Web site (www.hcfa.gov). Directions for downloading are on the insert accompanying this issue of Family Practice Coding Alert. The RVU file was also published in the November 2000 Federal Register. However, that version appears in a modified format, and column headings differ from those downloaded from HCFA and appearing in this story.

Columns A, B, C and D

Each column of the RVU file provides information of value to coders. The fields explained below are those that most affect family practice coding. Those that dont appear have minimal impact.

Column A lists the codes, while Column C contains abbreviated code descriptions. Column B (Modifiers) identifies whether the code has a professional or technical component. These are indicated with modifier -26 (professional component or PC) or modifier -TC (technical component), Butler says. If a code has both TC and PC portions and the field is blank, it generally means that the service is global.

Some codes may be reported any of these three ways, Butler notes, such as 73600 (radiologic examination, ankle; two views), which appears three times in the file once with no indication in the modifier column, once with modifier -TC and once with modifier -26. (See insert.) A family physician (FP) who owns x-ray equipment and interprets the films would assign 73600 globally, while the FP who performs an x-ray but then asks a radiologist to interpret the film would code 73600-TC.

Further information about these modifiers is in Column Q (PC/TC Indicator). Numeric indicators are assigned to each CPT code to specify which modifiers may be appended. A 0 in this column, for instance, signifies that the code represents physician services only (e.g., E/M codes) and that no -26 or -TC modifier applies. A 1 denotes a diagnostic service such as pulmonary function tests (e.g., 94010) where modifiers -26 or -TC may be used.

An indicator of 2 signals that the code describes the professional component only (e.g., [...]