Wiki DOS VS DATE OF INTERPRETATION

[nenetur]

Can anyone offer insight as to the difference? If the PFT 94060-26 was done on 8/20/19. The doctor interpreted the report on 8/25/2019. When Im billing for the 94060-26 what is the actual DOS to be listed? I thought the 26 modifier was to cover the equipment (hospital)....and the interpretation was included in the actual Billing for 8/20 no matter when the interpretation was read??? How do we justify an office/outpatient visit on 8/20 for the PFT if were going to bill the patient on 8/25/19.

 

[cgaston]

I have always used the actual date of service instead of the read date

 

[katemae84]

The 26 modifier is for the supervision and interpretation portion of the procedure- the "professional component" reported by the provider when they do their interpretation & report of a diagnostic service or procedure.
The facility expenses such as equipment is covered in the "technical component" which is billed using the TC modifier.
CMS advises that if a physician or NPP is providing a global service (both the technical & professional components of a diagnostic service) then the global code can be billed on either the date the TC component was performed or the date the interpretation & report was completed.
This CMS MLN Matters Article specifically relates it to radiology services, but since PFTs also have a TC/PC Indicator of 1 on the Medicare Physician Fee Schedule, the same logic applies.
Guidance on Coding and Billing Date of Service on Professional Claims
Commercial carriers may have their own date of service guidance, and if you're unsure of their policies, the best thing to do is search their reimbursement policies for an answer or reach out the carrier directly. I have always waited until the interpretation was completed and billed the service globally to commercial carriers with the read date as my date of service, since that is the date when the full CPT description of the code was completed.