Wiki Billing for TC and 26 Profesional

[phlebokim]

Morning,

How does a Physician owned practice, bill for procedures in which he performs the techinical component and the professional component. Does this require both a TC modifier and a 26 modifier for the professional component?

 

[jmcpolin]

You would bill the CPT with neither 26 or TC, so for instance 73030-RT or 73030-LT.

 

[armymomryan]

Depending on the insurance you may need to bill the code once with a 50 modifier, Medicare will not accept the RT or LT modifiers, it may also depend on the actual code, there is a book called "procedural coding expert" that gives you the bilateral rule for every code. If it is something that was not bilateral you would need no modifers, just bill the code 1 time (global)

 

[HMarean]

You would use no mods to bill it global. Check with your payors. I have come across a few that do like the tech and prof broken apart and billed seperate with seperate fees.

 

[armymomryan]

You would use no mods to bill it global. Check with your payors. I have come across a few that do like the tech and prof broken apart and billed seperate with seperate fees.

If it is a unilateral code and your doc did bilateral you would need a modifer to specify bilateral, you just would not need the 26-professional or TC technical modifers since you are global, you still may need 50, or RT and LT

 

[jmcpolin]

Armymomryan, I was just giving an example, the question was not about RT and LT modifiers. It was about 26 and TC.

 

[armymomryan]

Jenifer - yes, I understoood that, I was just adding a little clarification for her - since her status shows as new, a lot of new coders do not realize that Medicare won't accept the RT or LT

 

[DonnaFord]

Jenifer - yes, I understoood that, I was just adding a little clarification for her - since her status shows as new, a lot of new coders do not realize that Medicare won't accept the RT or LT

Medicare won't accept RT or LT in any case, or just certain codes.....?
Thanks, Donna