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Modifier -26

  1. Default Modifier -26
    Medical Coding Books
    So I was looking at an encounter and the provider orders and reads an x-ray of the left foot. Since the provider, "interprets" the x-ray, do I add modifier -26?

  2. #2
    Location
    Toms River, NJ
    Posts
    12
    Default Modifier 26
    Question: Did the performing radiologist do a separate interpretation prior to your doctor? If he did then, no you cannot bill for it. CMS has guideline for "rereads" or "wet reads" and they only pertain to ER services in case of life or death situations. Only one interpretation is payable normally. You can credit him with the interpretation in your E/M to factor into Medical decision making. He would get 2 points for complexity of data. That could support a higher level of E/M service, if warranted.

  3. Default Modifier -26
    The provider ordered and read the x-ray. There is no mention of radiologist.

  4. #4
    Location
    Toms River, NJ
    Posts
    12
    Default interpretation
    Then the provider can bill the radiology with a modifier 26. Just curious, was this radiology performed offsite? If it was done in the office, you can bill the global package without any modifiers (this supercedes using modifier TC and 26).

  5. #5
    Default
    Hi,
    So I was looking at an encounter and the provider orders and reads an x-ray of the left foot. Since the provider, "interprets" the x-ray, do I add modifier -26?
    For this scenario 26 mod is appropriate.

  6. #6
    Default
    There should not be a need to guess. Either the office send out x-rays to be read or they don't. Who is billing for the technical component? Is that contracted out or does the office own the equipment as well.
    CPC-P-A (11/2016), COC-A (9/2016), CPC-A (11/2015), PAHM (2010)
    Fee Schedule Configuration Specialist - Remote

    15 years health insurance experience: Audit, Claims, Customer Service, Payment Policy, Provider Relations, and Reimbursement

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