Wiki Use of modifier 26

[mskarengayebaker@yahoo.com]

I am a new medical coder and having the hardest time with modifier 26. ... when to use it and when not to. Can anyone give me any tips that might make this a little more clear? I know it is the professional component, but somehow it still is not clear to me

 

[subi]

mod-26

Hello,

Modifier 26 is appended for radiology n with some pathology codes

it is usually appended to bill for professional component


eg..if xray is being done and the technician does not belong to hospital we bill for technician with tc modifier

26 n tc will never come together

if the technician is employed in the hospital we bill for physician with mod-26

 

[mitchellde]

The TC is for the ownership of the equipment. The 26 is for the physician that performs the official interpretation. Not just X-rays but things like cardiac cath also. Any test/procedure that uses technical equipment as an integral part of the service, unless a separate code exists for the equipment and the interpretation such as EKGs.
Such as as physician office owns their own X-ray machine but sends out the films to be read by a radiologist. The office that owns the equipment uses the TC and the radiologist uses the 26.
There are occasions to use both like rural health. Medicare requests that the radiology be billed as two components.

 

[PVAzCPC]

The TC is for the ownership of the equipment. The 26 is for the physician that performs the official interpretation. Not just X-rays but things like cardiac cath also. Any test/procedure that uses technical equipment as an integral part of the service, unless a separate code exists for the equipment and the interpretation such as EKGs.
Such as as physician office owns their own X-ray machine but sends out the films to be read by a radiologist. The office that owns the equipment uses the TC and the radiologist uses the 26.
There are occasions to use both like rural health. Medicare requests that the radiology be billed as two components.

So which modifiers would I use for my provider(outpatient podiatry clinic) who actually performs the in-house xrays and provides the interpretations?

 

[twoerpel]

If you are providing both the technical service and the professional you would use no modifier on the code. In this way the provider will be paid the global service.

An example can be found at : http://www.aaos.org/news/bulletin/janfeb07/managing1.asp

 

[PVAzCPC]

Tyvm!