Wiki US Code 76857-New OB Coder with Question

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dballard2004

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Our clinic typically performs and interprets the ultrasounds that are done in our office. Most of the time, the patient sees the provider for a visit on the same date of service as the in-office ultrasound and the provider documents their interpretation within their office note. However, there are some rare occasions when the patient only comes in for an ultrasound and does not see the provider on the same date of service. The provider reviews and signs off on the ultrasound report, but I do not see a separate official interpretation of that ultrasound. I am wondering if in these cases we would have to append modifier TC to the ultrasound charge. Also, if the ultrasound is later interpreted by the same provider on a separate date of service, can we then bill for the ultrasound with the modifier 26?

I am referring to code 76857 for non-ob US.
 
dballard2004 said:
Our clinic typically performs and interprets the ultrasounds that are done in our office. Most of the time, the patient sees the provider for a visit on the same date of service as the in-office ultrasound and the provider documents their interpretation within their office note. However, there are some rare occasions when the patient only comes in for an ultrasound and does not see the provider on the same date of service. The provider reviews and signs off on the ultrasound report, but I do not see a separate official interpretation of that ultrasound. I am wondering if in these cases we would have to append modifier TC to the ultrasound charge. Also, if the ultrasound is later interpreted by the same provider on a separate date of service, can we then bill for the ultrasound with the modifier 26?

I am referring to code 76857 for non-ob US.
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Any takers?
 
In order to bill globally for the ultrasound, there must be a report/interpretation. One of the radiology organizations gives specifications as to what must be in the report. https://www.aium.org/docs/default-s...ocumentation-of-an-ultrasound-examination.pdf
I recall reading if the interpretation for radiology is done soon after, but on a date different than the date performed, it is acceptable to bill either the date performed or the date interpreted. I don't have that reference handy, but Google or searching on the forum may provide you with the reference.
If there is no interpretation, or it does not contain the necessary elements, then I would bill only for the -TC portion.
 
Found the reference regarding date of service for radiology. From Novitas MAC:

Radiology services​

Typically, radiology services have two separate components: a professional and technical component. These services will have a PC/TC indicator of “1” on the Medicare Physician Fee Schedule relative value file. The technical component is billed on the date the patient had the test performed. When billing a global service, the provider can submit the professional component with a date of service reflecting when the review and interpretation is completed or can submit the date of service as the date the technical component was performed. This will allow ease of processing for both Medicare and the supplemental payers. If the provider did not perform a global service and instead performed only one component, the date of service for the technical component would the date the patient received the service and the date of service for the professional component would be the date the review and interpretation is completed.
 
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