Wiki Modifier 26 & TC for OD Diagnostic Tests

[jpeterson015]

I need some further clarification on when we should split bill using the 26 & TC modifiers for our ophthalmologic diagnostic testing. We are a specialty clinic and own the testing equipment. My question is when our optometrists order the diagnostic testing that is performed by a technician employed by the practice and interprets it, should we be only bill the professional component or both professional and technical components? My understanding has always been that if the testing is performed at the physician's office, either by a physician or a technician employed by the practice we wouldn't split bill because the practice provided both components of the service. We are getting information that we should only be billing for the professional component. If anyone has any knowledge and can assist me, I'd appreciate it.

Thank you, Jodi Peterson, OCS Twins Cities Eye Consultants

 

[OpenClaims]

My employer advises us that if a procedure is done in the office that it doesn't need a modifier 26, however if it is performed outside of the office, then you would append the 26.

 

[csperoni]

I need some further clarification on when we should split bill using the 26 & TC modifiers for our ophthalmologic diagnostic testing. We are a specialty clinic and own the testing equipment. My question is when our optometrists order the diagnostic testing that is performed by a technician employed by the practice and interprets it, should we be only bill the professional component or both professional and technical components? My understanding has always been that if the testing is performed at the physician's office, either by a physician or a technician employed by the practice we wouldn't split bill because the practice provided both components of the service. We are getting information that we should only be billing for the professional component. If anyone has any knowledge and can assist me, I'd appreciate it.

Thank you, Jodi Peterson, OCS Twins Cities Eye Consultants

I agree with your understanding. If the company owns/rents the equipment, an employee actually performs the test, and your clinician interprets the test, you would bill without -26 or -TC. I would ask where you are getting the information from to only bill -26.
Here's an AAPC article about this When to Apply Modifiers 26 and TC

 

[Cheezum51]

Your question is a little unclear. When you say "our optometrist," are you referring to a OD also employed by your practice or a OD in another practice who refers the patient to your office for the tests?
If it's only a referral to do the test, then you bill the TC and the OD, who interprets the test would bill the 26. If the OD is an employee in your practice, then no modifiers are needed.

Tom Cheezum, OD, CPC, COPC