modifier 26

ndhight

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:confused: Hi,
I am confused about mod 26. I am taking my certification test Sat and need some explaination. When it comes to radiology and this mod I don't know when to use it. Example: When you have someone doing the test and someone else interpertating or the physician does the test and interperts. Thanks in advance for anyones help.
Nichole
 
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Modifier 26

Modifier 26 is used when procedures have a professional and a technical component. CPT modifier 26 designates the service as “interpretation only” and is most commonly submitted with diagnostic tests, including radiological procedures. You can refer to the Medicare Physician Fee Schedule database (MPFSDB) to determine if CPT modifier 26 is applicable to a particular procedure code.

For instance:

Dr. X, staff radiologist, interprets a chest x-ray that was obtained in the hospital Radiology Department. Dr. X is contracted with the hospital to read radiographs. The equipment and staff are owned and/or employed by the hospital.

Dr. X should report the chest x-ray code with modifier 26, professional component. If he had performed the service with equipment he owned and staff that he employed, he could have reported the global, but since the hospital assumed the technical overhead, he can only report the professional component.
 
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response to -26

from what I understand: -26 is used when there are findings of the radiology visit by a radiologist

:confused: Hi,
I am confused about mod 26. I am taking my certification test Sat and need some explaination. When it comes to radiology and this mod I don't know when to use it. Example: When you have someone doing the test and someone else interpertating or the physician does the test and interperts. Thanks in advance for anyones help.
Nichole
 

mbort

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the -26 modifier is for the professional component (radiologist/physician reading the films and documentation of such)

the -TC modifier is for the technical compononent (equipment and use thereof)

No modifier is necessary if the entity you are coding for houses the equipment and employs the person reading the films.

Hope this simplifies this for you. Good Luck on your test :)
 
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