Wiki Modifier 26 - reimbursement is reduced

[pilgrimx4]

Hi.

Looking for advice on the use of Modifier 26. It seems that most of the information I can find, everyone refers to this as the "interpretation" modifier. I have a physician that does interventional radiology (nephrology) procedures in the hospital setting, so he is using their equipment, but HE is perfoming the arteriogram, angiograms, fluoroscopies etc, not a tech or radiologist. He is properly documenting the procedures, and doesn't seem fair that his reimbursement is reduced to the extent that the 26 modifier does.

All help is sincerely appreciated!

 

[Walker22]

It is indeed fair. The part of the reimbursement that you "are not getting" is the part that is meant to reimburse the facility for the cost of purchasing and maintaining the equipment. If he wants to buy his own equipment, open a radiology center, and interpret the results, then he can get the "full" reimbursement!

 

[pilgrimx4]

Thank you so much for your courteous reply, however it does not answer my question. Since the physician is doing more than the "interpretation" is the modifier appropriate? or should I be billing it a different way?

 

[Walker22]

I apologize for offering an incomplete reply. Modifier-26 is not "just" an interpretation modifier. It is the "professional componant" modifier. That means it covers ALL services performed by the physician in relation to the code it was attached to. You are using it correctly, and getting paid the correct amount. I know this is not the answer you were hoping for, but it is the only one I have.

 

[AuntJoyce]

Modifier -26

Just to be absolutely clear...you are only putting the -26 on the radiological guidance part of the procedure...correct? The angiograms, etc. will not be subject to the -26 modifier and your docs should be billing for 100% of those portions of the procedure.

Talk about frustrating - what happened to days gone by where these wild and wacky modifiers were not even a thought?