Wiki Profee billing for surgeon

Create Wiki
E

easumma

Networker
Messages
43
Location
White Rock, NM
Best answers
0
I am billing for a surgeon on the professional component just making sure that all I need to do is add a mod 26 with the surgery code.
 
If your physician is performing a surgery you should not need a modifier 26. 26 is only use if someone else is billing a TC modifier. What codes are you billing. You also have to make sure the code you are submitting can be split like that. Some codes don't allow TC/26 modifiers. If you are billing for an out patient or inpatient surgery done in the office, at an ASC or in the hospital the physician bills the surgery codes and the facility bills their surgery codes there is no 26/TC modifiers used.
 

I think your question is more along the lines of billing for professional surgeon fees versus billing for the facility? As in, CMS-1500 vs. UB92.
The links above each have a decision tree which should help you understand.

Modifier TC & 26 only come into play when the codes have both a technical and professional component, like X-Rays.
The words global, professional and technical when used in reference to TC/26 or sometimes called TC/PC are not the same as when someone is talking about the global days (0, 10, 90) of a surgical procedure or pro-fee billing.
 
catherinetinkey@entmedicalservices.org said:
If your physician is performing a surgery you should not need a modifier 26. 26 is only use if someone else is billing a TC modifier. What codes are you billing. You also have to make sure the code you are submitting can be split like that. Some codes don't allow TC/26 modifiers. If you are billing for an out patient or inpatient surgery done in the office, at an ASC or in the hospital the physician bills the surgery codes and the facility bills their surgery codes there is no 26/TC modifiers used.
Click to expand...
I am billing for a hernia repair 49505. So I billed just with the CPT and BCBS did not pay. Do I need to put a different mod on it? The denial reason is the procedure code is inconsistent with the modifier used or a required mod is missing. So not sure where to go..
 
easumma said:
I am billing for a hernia repair 49505. So I billed just with the CPT and BCBS did not pay. Do I need to put a different mod on it? The denial reason is the procedure code is inconsistent with the modifier used or a required mod is missing. So not sure where to go..
Click to expand...
Did you have a modifier originally? Perhaps the payor wants a laterality mod??
 
easumma said:
I am billing for a hernia repair 49505. So I billed just with the CPT and BCBS did not pay. Do I need to put a different mod on it? The denial reason is the procedure code is inconsistent with the modifier used or a required mod is missing. So not sure where to go..
Click to expand...
Your denial for modifier on 49505 means they want laterality. For inguinal hernia you need a modifier RT for right side, or LT for left side. If bilateral hernia repair was done then use modifier 50 for bilateral procedure.
 
The only time I use 26 modifier is for ultrasound and fluoroscopy 76937 and 77001, when my surgeons do port A cath 36561.
76937,26
77001,26
36561, LT or RT (left or right vein access)
 
You must log in or register to reply here.
Top