Wiki Profee And Tc Modifier Question

[sburse]

We are receiving denials from a payer for profees because we have billed the technical component with TC and then the profee with 26. The payer said only one is required. Could someone verify this? The code is 93733.

 

[sjcochran]

26 & TC Modifiers

Are you filing the 26 and TC for same provider or different providers?

 

[sburse]

The same provider.

 

[LLovett]

Then why are you splitting the code up?

93733 alone is/was a global code it covers both professional and technical components.

Laura, CPC

 

[sburse]

The profee is for a 2nd interpretation by our on site physician. The TC is the actual Cardiac monitoring. I checked a claim and both are billed under the same NPI and TIN.

 

[mad_one80]

IT WOULDNT MATTER....THE -26 MOD is the the professional component( reading/interpretation only) and the -TC MOD for the technical component(cardiac monitoring) BUT if your same provider did both then you would not need any modifiers, like above person said....93733 is a global code....

www.highmarkmedicareservices.com/calendar/partb/pdf/2009-01-28-webinar-handouts.pdf

this is a modifier webinar...should help explain the usage/need for the modifiers billed.