Wiki Modifier -26 and TC

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aeades01

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Any advice on these two. I have had people try to explain to me but I still can't get my head wrapped around it. If you have a hospital based physician who performs a test and reads the test what would it be? Would it be no modifier since he did both? Or would you use both since it is a hospital based so
Would that be the technical component and -26 for the physician reading it and performing? I am so confused on these especially!
 
26 and TC

Hope this helps.

It really boils down to two questions. Is the equipment owned by the hospital and is the physician employed by the hospital or in his own clinic/practice which is not owned by the hospital..


Hospital owned equipment + physician works as employee of hospital = 93000

Hospital owned equipment (TC) and physician in own clinic/ practice(not owned by hospital) doing reads (26)


If the physician owns the equipment and is doing the read in his practice/ clinic (not owned by hospital) =93000

Hope this helps.
 
26 and TC

Is this also true for inpatient hospital?

If hospital owns the EKG machine,can hospital bill 93005-TC ?
cardiologist is reading EKG and providing the report, billing 93010-26, cardiologist is not employed by this hospital

I appreciate your input!
 
jennie2223 said:
Hospital owned equipment + physician works as employee of hospital = 93000
Click to expand...


Not necessarily. Even if the physician is an employee of the hospital, many hospitals continue to bill on both the UB and the 1500, meaning the physician interp/report would be billed on the 1500 form with the -26.

I think in order to answer this question, we need to know that.

aeades01, is your physician an employee of the hospital? If so, do you bill his services entirely on the UB, or on the 1500 form (so to speak). This is the million dollar question.

There would be no need to bill the global code on the 1500 form if the services are being provided at the hospital, because the hospital is always going to bill the technical charge on the UB. The only question here is if the physician's services are also being reported on the UB...which is unlikely.

I suspect this is an employed physician, with the TC being billed by the hospital and the physician billing the -26.
 
napahny@aol.com said:
Is this also true for inpatient hospital?

If hospital owns the EKG machine,can hospital bill 93005-TC ?
cardiologist is reading EKG and providing the report, billing 93010-26, cardiologist is not employed by this hospital

I appreciate your input!
Click to expand...

You do not use the TC and 26 modifiers with the codes for EKG as they are already descriptive for the individual components. You use the 93000 if you own the equipment and provide the reading, if then hospital owns the equipment and the physician provides the reading then the hospital bills the 93005 and the provider bills the 93010.
 
Pam and Debra
Thank you for your response.

Debra for pointing out unnecessary modifiers.

I'm trying to clarify if the same rules apply to acute inpatient hospital.
CMS chapter 13, 20.2.1 states "Hospital bundling rules exclude payment to suppliers of the TC of a radiology service for beneficiaries in a hospital inpatient stay".
Is this mean we can only bill for 93010- physician interpretation and report,
we are billing physician services on CMS 1500

Thank you,
 
this is great information, and i would like to get some clarification for modifier 26. any help would be greatly appreciated. my doctor does not own or use the ct scan equipment. nor does he do the initial interpretation of the scan. what he does do, is after receiving the report/cd images, he 're-interprets' the report/images-cd . he states that this is considered 'interpretation' and wants to append mod 26. i'm assuming that the radiologist, has already billed with modifier 26 as he is 'initially' interepreting the report, and we, as the dr office ordering the scan would not be able to bill . any help would be appreciated .thank you!
 
I would agree with you that your doc could not use mod -26. His independent interpretation could be used for a data point to partially justify a higher EM code, however
 
The only way your provider can bill for a re-read of a radiology/diagnostic test is if he clearly reports he is looking at the images, and has a different interpretation than the initial radiologist's opinion with his rationale. Merely looking at the images and then concurring with the radiologist's report is not a re-read, but as noted above, goes to a higher E&M code.
 
thank you for that. his rationale is that he has to view the images in order to identify and decide how to proceed with surgery, if the patient is 'healthy' enough to proceed with a 10-12hr procedure. so a higher EM code is something i will let doctor know we can possibly do, pending his documentation. thank you!
 
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