Wiki 26 Modifier usage

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encomma-watson

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Good day, everyone:

My offices do pap smears, but the reading of the pap smears goes to either the laboratory (i.e., Quest or LabCorp) or the hospital laboratory. Because we collect the specimens, can we add a 26 modifier to the pap smears? My other question is with EKGs, CPT code 93000, can we also use 26 modifiers since we perform the EKG, and another physician in the hospital read the EKG? I would like to use the modifier so that we can a little reimbursement back. Would like your opinion on this?
 
encomma-watson said:
Good day, everyone:

My offices do pap smears, but the reading of the pap smears goes to either the laboratory (i.e., Quest or LabCorp) or the hospital laboratory. Because we collect the specimens, can we add a 26 modifier to the pap smears? My other question is with EKGs, CPT code 93000, can we also use 26 modifiers since we perform the EKG, and another physician in the hospital read the EKG? I would like to use the modifier so that we can a little reimbursement back. Would like your opinion on this?
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Regarding PAPs, you do NOT bill the 8xxxx for collection. SOME carriers will recognize Q0091 which is a Medicare code. Otherwise, the collection is part of the visit.

Regarding other testing, -26 is specifically the professional component. It sounds like you are describing that your practice performs the technical component, and another physician is performing the professional component. If it is being done in an office setting and your practice is performing the technical component, that is what you would bill for.
 
@encomma-watson on your EKG CPT 93000 question you cannot bill it with a modifier 26 as it has a PC/TC indicator of 4-Global test only codes: This indicator identifies stand alone codes for which there are associated codes that describe: a) the professional component of the test only, and b) the technical component of the test only. Modifiers 26 and TC cannot be used with these codes. The total RVUs for global procedure only codes include values for physician work, practice expense, and malpractice expense. The total RVUs for global procedure only codes equals the sum of the total RVUs for the professional and technical components only codes combined.

CPT 93000-Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report is the CPT code for the global charge for the EKG.

If you are providing the technical component only of the EKG you would bill 93005-Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report.
It actually sounds like your practice is providing the technical component only since you are stating you are performing the test but another provider is providing the read of the EKG, in which case you would bill the 93005.

To bill for the professional component of an EKG, assuming your provider is interpreting the results and providing the report you would bill 93010-Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only. CPT 93010 is what the other physician at the hospital who is doing the interpretation and report on the EKG should be billing based on your original posting.
 
CBLENNIE said:
@encomma-watson on your EKG CPT 93000 question you cannot bill it with a modifier 26 as it has a PC/TC indicator of 4-Global test only codes: This indicator identifies stand alone codes for which there are associated codes that describe: a) the professional component of the test only, and b) the technical component of the test only. Modifiers 26 and TC cannot be used with these codes. The total RVUs for global procedure only codes include values for physician work, practice expense, and malpractice expense. The total RVUs for global procedure only codes equals the sum of the total RVUs for the professional and technical components only codes combined.

CPT 93000-Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report is the CPT code for the global charge for the EKG.

If you are providing the technical component only of the EKG you would bill 93005-Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report.
It actually sounds like your practice is providing the technical component only since you are stating you are performing the test but another provider is providing the read of the EKG, in which case you would bill the 93005.

To bill for the professional component of an EKG, assuming your provider is interpreting the results and providing the report you would bill 93010-Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only. CPT 93010 is what the other physician at the hospital who is doing the interpretation and report on the EKG should be billing based on your original posting.
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Thank you for answering this question, now I understand it.
 
csperoni said:
Regarding PAPs, you do NOT bill the 8xxxx for collection. SOME carriers will recognize Q0091 which is a Medicare code. Otherwise, the collection is part of the visit.

Regarding other testing, -26 is specifically the professional component. It sounds like you are describing that your practice performs the technical component, and another physician is performing the professional component. If it is being done in an office setting and your practice is performing the technical component, that is what you would bill for.
Click to expand...
What I am describing is the provider is in the room with the CMA and patient. The provider does the collecting of the smear, places it in a tube and sends it to the hospital lab (we are with the hospital system). The lab tech, I am thinking looks at the smear and the laboratory provider is reading it and giving a diagnosis. I think I am getting confused about the -26 modifier (Professional Component) and TC (the technical component).
 
encomma-watson said:
What I am describing is the provider is in the room with the CMA and patient. The provider does the collecting of the smear, places it in a tube and sends it to the hospital lab (we are with the hospital system). The lab tech, I am thinking looks at the smear and the laboratory provider is reading it and giving a diagnosis. I think I am getting confused about the -26 modifier (Professional Component) and TC (the technical component).
Click to expand...
For tests that have a technical and professional component, the technical portion is for the equipment and the person actually performing the test - the professional component is the physician reading & interpreting the results.
PAP tests do not have a technical and professional component.
 
csperoni said:
For tests that have a technical and professional component, the technical portion is for the equipment and the person actually performing the test - the professional component is the physician reading & interpreting the results.
PAP tests do not have a technical and professional component.
Click to expand...
OK Thank you for that. I am trying to bring up revenue, but I am respecting what I can and cannot bill or code. Thank you once again for answering my question.
 
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