Wiki BILLING WITH 26 AND TC MODIFIERS

[AHearley]

We are an independent radiology practice that is contracted to read all imaging services and provide services at our local hospital and clinics, Recently some of our claims are being denied because we are billing for the service such as 19085 because our radiologist is performing the service, however the hospital or outpt facility is billing this service as well and not putting a TC on their claim. This is on a HCFA claim form. We feel this is incorrect because they aren't performing the service they are billing for the room, equipment etc. Should their claim have the TC or not? And why would they use the same CPT code?
Same situation when services we perform in the hospital are being billed on a UB and no TC indicated.
Any thoughts or anyone who does bill this type of scenario? Thank you in advance!!

 

[thomas7331]

If the facility is billing on a UB-04 form, a TC modifier is not required because only technical charges go on the UB-04 under the radiology revenue code. It's understood that the hospital is only billing the technical component. If your payer is denying your professional charges and is saying that they were already paid to the hospital on the UB, then that is the payer's error and they are giving you incorrect information.

 

[CBLENNIE]

In general, I agree with thomas7331's response. However, I worker for a payer and would like to throw in the idea that a facility could also be billing the professional fee revenue codes for radiology services 0971, 0972 and 0973. While it isn't common for most facilities to bill for the professional fee revenue codes, it does happen in certain types of facilities, such as FQHCs, RHCs, CAHs and teaching hospitals.

Per Noridian these revenue codes are defined as follows:
097x - Professional Fees (Extension of 096x)
0971-Radiology - diagnostic
0972-Radiology - therapeutic
0973 Nuclear Medicine

If the facility billed one of these revenue codes and your professional fee procedure code crosswalks to the revenue code, then the payer is correctly advising you that the facility was paid for the professional service you are also billing for.