Wiki Modifier 26 with codes having phrase 'S & I'

[aapcebills@gmail.com]

Can someone provide clarification with the use of codes that has the phrase "Radiological Supervision & Interpretation" -- I read somewhere that when the code has "Radiological Supervision & Interpretation", that the '26' modifier would not be reported as that code already includes the 'professional component'.

i.e. 72291

 

[mhstrauss]

Can someone provide clarification with the use of codes that has the phrase "Radiological Supervision & Interpretation" -- I read somewhere that when the code has "Radiological Supervision & Interpretation", that the '26' modifier would not be reported as that code already includes the 'professional component'.

i.e. 72291

I really can't explain why, as I don't understand it myself, but per the CMS RVU file, 72291 does break down into TC/PC components. I know there are many other "S&I" codes this way also. Wish I could help more

 

[MarcusM]

http://www.or.regence.com/provider/...omponent-modifier-tc-technical-component.html

CPT modifier -26 represents the professional (provider) component of a service or procedure and includes the provider work, associated overhead and professional liability insurance costs. This modifier corresponds to the human involvement in a given service or procedure.

HCPCS Level II modifier -TC represents the technical component of a service or procedure and includes the cost of equipment and supplies to perform that service or procedure. This modifier corresponds to the equipment/facility part of a given service or procedure.

Unmodified procedure codes represent a complete service or procedure that includes both the professional and technical components.

For CPT 72291, see the information below:

http://downloads.cms.gov/medicare-c...achments/30516_9/L30516_RAD032_CBG_060111.pdf

 

[mmoorer]

MarcusM I have a question for you. I currently bill for a Urgent Care practice and we perform the actual X-rays here but the films are sent to a 3rd party to generate an official report. I was instructed to bill the x-rays with modifier -TC but I have been doing some research and i'm not quite sure this modifier is correct, and reading your response it seems like we should be billing for the complete service. I am a little confused , please help ??
Thank You in advance !
Melissa M, CPB

 

[MarcusM]

If you a doing the X-ray in the office, then you bill for the facility charge or technical component. Since you are sending the images out for a radiologist to interpret the images, he/she will bill the same CPT code with the 26 modifier to show he/she did the review and generated the official report. If at some point, your practice has someone qualified to review the images in house and then generate the official report, then you would bill the whole component. A good example is a non-cardiologist doing an EKG but having to send the EKG strip to a cardiologist to interpret the squiggles.