Modifier 26

[MKESSINGER]

Hi, can anyone tell me what the documentation requirements are to bill modifier 26 with ob ultrasound? I have a physician who only documents "breech presentation" only and wants to bill for reading the ultrasound, I want to make sure I am coding correctly. Thank you

 

[csperoni]

If I was being audited, I could not look the auditor in the eye and say there was an interpretation of a full OB ultrasound if all that is documented is "breech presentation". I would consider it for the limited OB ultrasound 76815 Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses

 

[staz01]

What if the physician does the ultrasound in the hospital, performing and interpretation with complete documentation? The hospital owns the equipement, but the physician did all the work with no assistance from hosptial staff. Do we still have to append the modifier 26?

 

[csperoni]

What if the physician does the ultrasound in the hospital, performing and interpretation with complete documentation? The hospital owns the equipement, but the physician did all the work with no assistance from hosptial staff. Do we still have to append the modifier 26?

Yes. As the hospital facility owns the equipment, only the facility can bill for the technical component. While in that scenario, your physician is doing more work than if the hospital tech had performed the ultrasound, -26 and -TC is the only way I am aware to split it.

 

[nielynco]

Yes. As the hospital facility owns the equipment, only the facility can bill for the technical component. While in that scenario, your physician is doing more work than if the hospital tech had performed the ultrasound, -26 and -TC is the only way I am aware to split it.

Unless the hospital radiologist did the interpretation as well. In that case only one can bill for the professional component and that would likely be the hospital radiologist with the OB having to settle for interpreting the result as part of medical decision making.