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26 modifier on a surgery code??

  1. #1
    Default 26 modifier on a surgery code??
    Medical Coding Books
    Our facility bills out a claim for the facility fee on our surgeries and then we bill a separate professional claim for the physician fees. Our facility coder is telling us we need to bill a 26 modifier on our professional claim for procedure 44970 (Laparoscopic Appendectomy). Is this correct? I have never billed 26 modifiers on surgical codes before. Can someone please provide some insight? Thank you!

  2. #2
    That is not correct - surgical procedures do not have technical and professional components. If you look up any code on the CMS website under the physician fee schedule, it will tell you the PC/TC indicator, which designates whether or not the code includes these components. CPT 44970 does not have a professional component and billing that code with modifier 26 would be an error.
    Thomas Field, CPC, CEMC

  3. #3
    Default thanks
    Thank you thomas! I thought I was going crazy!

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