Results 1 to 5 of 5

Modifier 26 - reimbursement is reduced

  1. Question Modifier 26 - reimbursement is reduced
    Exam Training Packages

    Looking for advice on the use of Modifier 26. It seems that most of the information I can find, everyone refers to this as the "interpretation" modifier. I have a physician that does interventional radiology (nephrology) procedures in the hospital setting, so he is using their equipment, but HE is perfoming the arteriogram, angiograms, fluoroscopies etc, not a tech or radiologist. He is properly documenting the procedures, and doesn't seem fair that his reimbursement is reduced to the extent that the 26 modifier does.

    All help is sincerely appreciated!

  2. #2
    It is indeed fair. The part of the reimbursement that you "are not getting" is the part that is meant to reimburse the facility for the cost of purchasing and maintaining the equipment. If he wants to buy his own equipment, open a radiology center, and interpret the results, then he can get the "full" reimbursement!
    Walker Bachman, CPC, CPPM

  3. Default
    Thank you so much for your courteous reply, however it does not answer my question. Since the physician is doing more than the "interpretation" is the modifier appropriate? or should I be billing it a different way?

  4. #4
    I apologize for offering an incomplete reply. Modifier-26 is not "just" an interpretation modifier. It is the "professional componant" modifier. That means it covers ALL services performed by the physician in relation to the code it was attached to. You are using it correctly, and getting paid the correct amount. I know this is not the answer you were hoping for, but it is the only one I have.
    Walker Bachman, CPC, CPPM

  5. Wink Modifier -26
    Just to be absolutely are only putting the -26 on the radiological guidance part of the procedure...correct? The angiograms, etc. will not be subject to the -26 modifier and your docs should be billing for 100% of those portions of the procedure.

    Talk about frustrating - what happened to days gone by where these wild and wacky modifiers were not even a thought?

Similar Threads

  1. Replies: 2
    Last Post: 09-18-2015, 02:17 PM
  2. Modifier 59 vs Modifier 91 for Laboratory
    By leahrey in forum Modifiers
    Replies: 1
    Last Post: 06-23-2015, 01:01 PM
  3. MODIFIER PT VS MODIFIER 33 Screening Colonoscopy
    By Ann Johnson in forum Modifiers
    Replies: 2
    Last Post: 07-19-2012, 08:08 AM
  4. Modifier 58 versus Modifier 78
    By Ramona03 in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 06-04-2012, 01:10 PM
  5. Modifier 51 Versus Modifier 59
    By Sborkowski in forum Modifiers
    Replies: 3
    Last Post: 05-26-2009, 04:59 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.