26 and TC modifier

[kreis17]

I work for a pain management physician who also owns an ASC where he performs some of his procedures. I an responsible for the coding for his practice and the ASC and need some help on this. If he perform a 64490 in the ASC do I append the TC modifier to the claim for the ASC and then for his practice code the 64490 with a 26 modifier?

 

[pedscoder21]

CPT 64490 does not allow modifier TC or 26 (there isn't a professional and technical component of this code).

 

[kreis17]

CPT 64490 does not allow modifier TC or 26 (there isn't a professional and technical component of this code).

I am very new to coding and have not been certified yet so please excuse my ignorance here. Can I bill the code for the physician and for the ASC WITHOUT the modifiers?

 

[thomas7331]

You would bill the physician's code without a modifier but use the appropriate place of service code 24 if the procedure was done in the ASC. For surgical procedures without a professional/technical component, the payers know to allow a reduced rate for the physician based on a facility place of service since the facility will charge separately for the use of the equipment and space. No modifier is necessary for the ASC claim either - since the provider type is a facility, it is understood that those are technical charges only.

 

[kreis17]

You would bill the physician's code without a modifier but use the appropriate place of service code 24 if the procedure was done in the ASC. For surgical procedures without a professional/technical component, the payers know to allow a reduced rate for the physician based on a facility place of service since the facility will charge separately for the use of the equipment and space. No modifier is necessary for the ASC claim either - since the provider type is a facility, it is understood that those are technical charges only.

Thank you so much!!