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Modifiers TC and 26

  1. #1
    Location
    Overland Park, KS
    Posts
    1,166
    Default Modifiers TC and 26
    Exam Training Packages
    I understand the difference between these modifiers, but I have a question regarding the correct use.

    We only perform the x-ray at my clinics. We send the x-rays out to be read by an outside radiologist. We have a contract with the radiologist for the reading of the films and we pay him/her for this service. My question is do we still appended modifier TC to our x-rays since we pay the radiologist for the read? I don't know if the radiologist bills or not. Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  2. #2
    Location
    Evansville Indiana
    Posts
    451
    Default Modifier TC and 26
    If you have a contract and are paying the radiologist to read the x-rays, then you should be billing globally and they should not be billing. If he is billing then you shouldn't be paying him for a service that he is already being paid for by the insurer.

  3. #3
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks so much!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    Dawson,

    I completely agree with Cheermom. I've experienced similar arrangements and this is exactly how we handled the billing.

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