Wiki Who can bill the 26 modifier?

[Missbreezy1]

Hello, our organization is contracted with a Radiology group. The Radiology group does not have a Cardiac Imaging Physician, and the Cardiology group does not have a Radiologist. So, the Cardiologist reads the image and makes determination based on his specialty and sends it to the radiology group for the overread. Can the Cardiologist bill a TC & 26 AND the Rad group bill the 26 or does the 26 have to be billed as one (under the rad group)?

 

[whatwouldyousay]

What study is being interpreted by radiologist?

Radiology group may need to set up an agreement to bill the cardiologist for their interpretation of the study.

 

[Missbreezy1]

Hi, it could be an X-ray, US, etc. (most radiology services).

 

[CBLENNIE]

Can the Cardiologist bill a TC & 26 AND the Rad group bill the 26 or does the 26 have to be billed as one (under the rad group)?

From the payer perspective, we are not going to be OK with paying 2 physicians for the professional component of a service that has both a technical and professional component.

If the cardiologist is writing the report interpreting the results of the procedure in addition to the performing the technical component, then they can bill for the global charge, in which case they would bill the CPT/HCPCS code w/o the TC and 26 modifiers.

However, if the radiologist that is writing the formal report interpreting the results of the procedure, then the cardiology group should bill the CPT/HCPCS code with the TC modifier and the radiology group should bill the CPT/HCPCS with the 26 modifier. Assuming that the cardiology group owns the equipment and is performing the test and it is not being done in a facility.

 

[AmandaBriggs]

Our organization has an agreement with our radiology group. The radiologist bills the interpretation charge, and then they reimburse our cardiology group for a portion of the interpretation on the back end.