20985 with 26 modifier?

tobieforte

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New Orleans, La
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I should know this, but orthopedics are new to me. Can someone PLEASE explain why I would not attach a "26" modifier to a 20985?? My doctor is charging it with a 27447. I was reasoning that we don't own the navi equipment therefore "26" modifier, but that doesn't seem to apply. Whyyyy?
 

CodingKing

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CPT has a code has a PC/TC indicator of 0 which means:

Physician Service Codes -- Identifies codes that describe physician services. Examples include visits, consultations, and surgical procedures. The concept of PC/TC does not apply since physician services cannot be split into professional and technical components. Modifiers 26 and TC cannot be used with these codes. The RVUS include values for physician work, practice expense and malpractice expense. There are some codes with no work RVUs.

I would assume that your physician is paying the equipment supplier directly for use of the equipment.

Not owning equipment does not automatically mean billing a 26. Its not who owns the machine, its who is billing for the technical component. For instance if a doctor does not own a machine and the office can "rent" the machine and the tech for the day. The equipment owner has the option to bill for the technical component on their own or if they don't want to deal with the overhead just charge the physician. The physician recoups the expense billing globally.
 
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tobieforte

Networker
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New Orleans, La
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The hospital where he did the procedure owns the equipment. I am clearer on the reasoning after your explanation. Thank you for your response.
 
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Eclectic, AL
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Have you had any issues with payment for the 20985 from insurance companies? I am not receiving payment from any of our carriers in Alabama for that code with the 27447. Should we put a modifier on either one of these or just the two codes? Thanks!
 
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