Wiki Coding an E/M with modifier 26 ?

[joanne kenny]

This just came up at my job and I wanted to verify the information. As far as I know an E/M code would not be billed with a modifier 26. However; the question has been raised that if a facility is billing for the E/M would they be able to bill an E/M with a 26 modifier for provider based billing? Any information would be helpful?

 

[reneehayes]

According to Novitas Modifier -26 "Professional Component: Certain procedures are a combination of a physician component and a technical component. When the physician component is reported separately, the service may be identified by adding the modifier 26 to the usual procedure number. This modifier must be reported in the first modifier field."

This is not a modifier to be used with any Evaluation and Management code from my understanding.

Hope this helps,

ReNee Moss, CPC

 

[MarcusM]

Modifier 26 is usually used for interpretations by a physician when a facility provides the technician who does the imaging, for example. So 73050 Shoulder; AC Joints might have the TC modifier for the facility and the 26 modifier for the radiologist who does the interpretation.

 

[mitchellde]

No the facility nor the physician uses a 26 with an E&M code. When the provider performs a service in the Hospital based clinic the provider uses a POS 22 and is reimbursed only for the professional component, When the facility submits the facility claim with a bill type for outpatient and rev code 510 then they are reimbursed for the overhead. The facility and the physician are not required to use the same level of service for the visit level.