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professional-26 / TC

  1. #1
    Default professional-26 / TC
    Medical Coding Books
    can any one give me a medical scenario of a professional component and a technical component please.


    Cori Sampson

  2. #2
    Kingsport, TN
    For performing the x-ray we bill with a TC modifier. We contract a radiology group to interpret the x-ray and provide a report, and they bill with 26 modifier. Hope this answers your question.

  3. Smile
    Our Physicians read and dictate a report of the results after a diagnostic test such as a doppler or Ultra sound is done by a diagnostic facility..the facility owning the equipment bills with TC and we bill with 26. But if you own the equipment and say you are doing dopplers in your office and then the same physician is also reading and dictating a report, then you bill with neither the 26 or TC because your billing the full component. So in other words, if you own the equipment that is doing the work that = the technical side of the component and the part done by the physician of interpretation is the professional component.

  4. #4
    There's lots of codes that are divisible into the technical/professional components...such as xrays, scans, other diagnostic testing such as echocardiograms, nuclear stress testing, EEG's, conduction studies, etc. There are also some lab codes that are as well. The easiest way to see if a code is divisible is to look it up on the Medicare fee schedule, and select TC or 26. The TC modifier is usually the facility that owns the equipment used to perform the procedure. The 26 is the person who reads/interprets the procedure. An example is our cardiologists own the echo machine in their office, when they bill, they don't use any modifier because they are billing globally- for both TC and 26. When they see a patient in house/inpatient they bill with the 26 modifier because the only they are doing is reading/interpreting the test. The hospital owns the echo equipment for which they are billing for the technical component.

  5. Default Modifier 26 - TC
    What if the code that is being billed is for radiological supervision and interpretation (example: 76942) Do you add the modifier 26 to that code for the physician who does it or does the code stand alone as a professional component code?

  6. #6
    For codes that are "interp and report" and are not divisible into TC or 26, yes you would bill them alone. However, there are a few payors that want the 26.

  7. #7
    The TC component is to be coded by whomever owns the equipment.

    The 26 component is to be coded by whomever reads/interprets/reports.

    No modifier would be necessary if for example you work in a orthopedic practice who has their own x-ray equipment. They claim the full component.

    If your doctor goes to an ASC, the ASC owns the equipment, therefore they claim the TC portion. The doctor in the OR reads/interprets the films, therefore he can only claim the -26 portion.

    Hope this helps

    Mary, CPC, COSC

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