Wiki Global, TC , 26 modifiers

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JENSULLIVAN

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Can someone help me on our situation. In our outpatient hospital setting we do echos, 93306, EEGs 95819, cardiac stress test 78452 for example. I noted these all have a PC/TC indicator 1. I'm understanding that it means we can bill global without a modifier or bill with a TC and the outside physician bill the PC with 26 modifier. In all of these situations, we own the equipment but not the physician. We have been billing, for example, 95819 with no modifiers and the outside neuro bills 9581926. Both are being paid. Are we double charging for the profee? In another situation, we need to charge global for echos 93306, we own both dr and equipment. What form and how do we indicate global on this one?
 
JENSULLIVAN said:
Can someone help me on our situation. In our outpatient hospital setting we do echos, 93306, EEGs 95819, cardiac stress test 78452 for example. I noted these all have a PC/TC indicator 1. I'm understanding that it means we can bill global without a modifier or bill with a TC and the outside physician bill the PC with 26 modifier. In all of these situations, we own the equipment but not the physician. We have been billing, for example, 95819 with no modifiers and the outside neuro bills 9581926. Both are being paid. Are we double charging for the profee? In another situation, we need to charge global for echos 93306, we own both dr and equipment. What form and how do we indicate global on this one?
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On the equipment you own that outside Dr.'s read you should only be billing the code with the TC modifier as the outside Dr. will be billing the read.

On the equipment that you own and your docs read you can bill with the pure code for the global service.

:)
 
Is it possible that we could be double billing for profees if our hospital is charging 93306 with no modifiers on UB04 and the physician is biling 93306-26 from his practice? And both are getting paid.
 
If you are billing on a UB with revenue codes in the 3XX-8XX range, then you are only billing for the technical component and don't need a modifier. On the UB, the professional component would be billed with revenue codes 960-989.

The PC/TC indicator you're referring to is from the physician fee schedule, which only governs 1500 form submissions, so on a professional claim you need to apply the correct modifier(s) or bill globally with no modifiers. If you omit the 26 modifier and use a facility place of service, most payers will automatically pay the PC only under the assumption that the TC belongs to the facility.
 
Is it better to bill globally on 1500 with no modifiers, if we own equipment and doctors vs splitting the codes apart -TC on UB04 and 26 on 1500?
 
I don't think you have a choice. You would need to bill according to how your facility is licensed/credentialed and per your contracts with the payers. That's what would drive your reimbursement as well. And if your place of treatment is a hospital or facility (POS 21-24), you cannot bill any technical components on a 1500 form unless directed to do so by the payer in the contract.
 
So I have a question if Im billing UB04 Pain injections 64490 and 72100imaging TC modifier. Then I bill professional pain for physician on CMS-1500 to bill professional so I would bill 64490-26 and 72100-26?
 
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