stpat
Networker
Is there ever a situation where you could append a modifier 26 to an E/M code?
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Wiki mod 26
- Thread starter stpat
- Start date
mbort
True Blue
no, the 26 modifier is for the professional component of some services (ie, x-rays, ultrasound, etc)
stpat
Networker
The situation is the hospital will soon own the physician office and believes that modifier 26 should be attached to the E/M code to signify that we are providing the professional component in their facility. I can't find any literature anywhere that disputes or supports this.
mbort
True Blue
www.wpsic.com/medicare/part_b/education/modifier_26.pdf
There are no TC components to E/M codes so its impossible.
There are no TC components to E/M codes so its impossible.
Last edited:
kbarron
Guest
We are a hospital owned practice and the only time 26 is used is for 59025. When ekg are done we use 93010.
RebeccaWoodward*
True Blue
E/M codes have a payment status indicator of zero (0)
http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp
0=Professional Component/Technical Component Indicator (PC/TC)
0 Physician service codes: This indicator identifies codes that describe physician services. Examples include visits, consultations, and surgical procedures. The concept of PC/TC does not apply since physician services cannot be split into professional and technical components. Modifiers 26 and TC cannot be used with these codes. The total RVUs include values for physician work, practice expense and malpractice expense. There are some codes with no work RVUs.
http://medicare.fcso.com/Fee_resources/137945.pdf
http://www.cms.hhs.gov/pfslookup/02_PFSsearch.asp
0=Professional Component/Technical Component Indicator (PC/TC)
0 Physician service codes: This indicator identifies codes that describe physician services. Examples include visits, consultations, and surgical procedures. The concept of PC/TC does not apply since physician services cannot be split into professional and technical components. Modifiers 26 and TC cannot be used with these codes. The total RVUs include values for physician work, practice expense and malpractice expense. There are some codes with no work RVUs.
http://medicare.fcso.com/Fee_resources/137945.pdf
stpat
Networker
Thanks so much to all of you!!