S&I codes and modifier 26

codemeister

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I'm confused as to why it's necessary to add modifier 26 to a code that has "radiological supervision & interpretation" in its descriptor. Since S&I are inherently professional components of a surgical procedure (something done by a physician or radiologist, rather than a technician) adding 26 seems redundant. For example, 76942 Ultrasonic guidance for needle placement, rad S&I ... isn't the work of the technologist and the use of the imaging equipment billed by the facility along with their charge for the surgery?

Some materials I read say the S&I code is always correct with no modifier and some say it requires 26 when the radiologist is an independent physician, not employed by the facility. Any guidance on this? The Guidelines ar the beginning of the Radiology Section are not very specific.
 

cblack712

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26 mods must be applied to any services in which the physician does not own the equipment in which the services are rendered. S/I codes are not exempt from this policy. Supervision and Interp is just what is says - the physician must be present for the exam and must interp the exam. Basically, those codes indicate that the physician could be billing for a procedure outside of the 70000 code range if he/she performed the procedure, supervised the procedure and interpreted the procedure. For instance, a hysterosalpingography a radiologist could invuse the saline and then interpret the procedure so you would bill 58340 / 74740.26. If the OB infuses the saline or contrast and the radiologist watched and provided findings the ob would bill 58340 and the radiologist would bill 74740.26
The 26 modifier has nothing to do with S/I, it is all about who owns the equipment.

Hope that helps some!
Carrie
 
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