78452 - (TC & 26 Modifiers)

crhunt78

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Our Cardiologists own their own MPI SPECT imaging equipment but we have a group who is billing code 78452 with a TC modifier. The office is telling us (we do our coding off site) that a tech does the test and a physician reads or interprets the test therefore, it is reasonable to bill the 78452 with a TC modifier. I do not agree with this because the doctors own their own equipment, not a hospital or some other entity. I believe it should be billed as 78452 with the appropriate interpretation code from 93015-93018 and, of course, the drug codes. I don't believe any modifiers should be attached. Am I correct or do we need to use the TC modifier to show the physician owns the equipement?
 

donnajrichmond

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Alexandria, LA
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Are they wanting you to bill 78452-TC and 78452-26?
If you own your own equipment, do the service in your own office, using your own staff and supplies, and it is interpreted by your own doctor, then 78452 without a modifier. Along with 93015 (assuming own equipment, interpretation, etc.), radiopharmaceutical and drug codes.

"The office is telling us (we do our coding off site) that a tech does the test and a physician reads or interprets the test therefore, it is reasonable to bill the 78452 with a TC modifier." - that explanation from the office only makes sense if no one from that office is providing the interpretation of the myocardial perfusion scan. Are they, perhaps, getting a radiologist to do the interpretation and the radiologist is billling for the interpretation?
 

crhunt78

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Mission, KS
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Are they wanting you to bill 78452-TC and 78452-26?
If you own your own equipment, do the service in your own office, using your own staff and supplies, and it is interpreted by your own doctor, then 78452 without a modifier. Along with 93015 (assuming own equipment, interpretation, etc.), radiopharmaceutical and drug codes.

"The office is telling us (we do our coding off site) that a tech does the test and a physician reads or interprets the test therefore, it is reasonable to bill the 78452 with a TC modifier." - that explanation from the office only makes sense if no one from that office is providing the interpretation of the myocardial perfusion scan. Are they, perhaps, getting a radiologist to do the interpretation and the radiologist is billling for the interpretation?
They only want us to bill a 78452-TC along with the 93015 and drug codes. I agree with you but we are getting a lot of argument from this office. They are new to our practice and they don't have a full time coder. This is a charge entry person who uses a "cheat sheet" that was made for her before we took over. I think they are not getting paid the full amount they should be because they are billing the 78452 with the TC modifier. Luckily we have to review their charges before they are sent to insurance so we can fix it but we can't figure out how to make them understand that they don't need the modifier.
 

crhunt78

Guru
Messages
154
Location
Mission, KS
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Are they wanting you to bill 78452-TC and 78452-26?
If you own your own equipment, do the service in your own office, using your own staff and supplies, and it is interpreted by your own doctor, then 78452 without a modifier. Along with 93015 (assuming own equipment, interpretation, etc.), radiopharmaceutical and drug codes.

"The office is telling us (we do our coding off site) that a tech does the test and a physician reads or interprets the test therefore, it is reasonable to bill the 78452 with a TC modifier." - that explanation from the office only makes sense if no one from that office is providing the interpretation of the myocardial perfusion scan. Are they, perhaps, getting a radiologist to do the interpretation and the radiologist is billling for the interpretation?
They only want us to bill a 78452-TC along with the 93015 and drug codes. I agree with you but we are getting a lot of grief from them and they will not put the charge in without that TC modifier on it. I think that this is causing a loss of revenue because they are only getting paid for the equipment and not the rest of the work involved.
 
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