Results 1 to 7 of 7

Using Modifier 26 with CPT Add-on Codes

  1. Default Using Modifier 26 with CPT Add-on Codes
    Exam Training Packages
    I have a question on using modifier 26 with cpt add-on codes 77001 and 77002. Our practice management software is stating that we need to add modifier 26 for the professional component of the cpt. However, our physician is arguing that we are not suppose to use modifier 26 with add-on codes. Does anyone have any information that they can share on the usage of modifier 26 on add-on codes?

  2. #2
    Location
    Louisville, KY
    Posts
    24
    Default
    Fluoroscopic guidance can be used independently or in combination with other imaging methods; therefore, it is important to refer to the code descriptors, parenthetical instructions, and introductory notes for specific reporting instruction. For example, fluoroscopic guidance (77002) is inclusive of all radiographic arthrography with the exception of supervision and interpretation for computed tomography and magnetic resonance arthrography. Therefore, it is not appropriate to report 77002 in addition to codes 70332, 73040, 73085, 73115, 73525, 73580, and 73615.
    Fluoroscopic guidance is inclusive of organ or anatomic specific radiological supervision and interpretation procedure codes 74320, 74350, 74355, 74445, 74470, 74475, 75809, 75810, 75885, 75887, 75980, 75982, and 75989.

    If the physician is not present in the operating room during a procedure that uses fluoroscopy or fluoroscopic guidance, that physician should not submit a code for fluoroscopy because fluoroscopic imaging requires personal supervision. However, the appropriate radiographic code to report the anatomy evaluated should be submitted in the event that (1) the radiologist's contract with the hospital requires that a radiologist issue a formal interpretation or (2) the physician performing the study requests that a radiologist produce a formal report of the procedure from permanent images recorded.

    This is from CPT Assistant, February 2007 Page 11

    Anthony Bush, CPC, CCP
    Medical Records Review Coordinator

  3. Default
    What if the physician is inserting the port access in the office. Would we bill the cpt with a modifier 26? And is modifier 26 appropriate for add-on codes?

  4. #4
    Location
    Louisville, KY
    Posts
    1,101
    Default
    Ok, I think you have a bit going on here.

    -26 may be appended to add-on codes for which there is the TC/26 breakout.

    However, if these are being done in the office, I'm wondering if the physician owns his own equipment; I'm also curious as to whether any Radiologists are reading the films behind the physician or anything wacky like that.

    For all sakes and purposes, -26 and -TC are added (and therefore, broken out) when two different entities (typically) are reporting the same service--think Physician(26) and Hospital(TC). If your physician owns and operates the equipment being used , etc, then it would not be necessary to append these modifiers.

    By the way, 77002 is not an add-on.

    Hope this helps.

  5. #5
    Location
    Louisville, KY
    Posts
    24
    Default
    According to CPT, when reading about code 77001 it is an add on code. In the description of the code it states: "includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic SUPERVISION and INTERPRETATION, and radiographic documentation of final catheter position." According to this you can not use a modifier -26...the supervision and interpretation is inclusive to 77001.

  6. #6
    Location
    Louisville, KY
    Posts
    1,101
    Default
    Actually, the only radiology code on which you can't append a Mod-26 is 76140.

    It is acceptable under the appropriate circumstances to append -26 to everything else out of Radiology (and some other areas of CPT).

    Hope this makes sense.

  7. Default 77001
    Our state Medicaid program fee schedule breaks out code 77001 with the global code, the code with -TC modifier and the code with -26. I would certainly check with your payers and verify how they want your services submitted.

Similar Threads

  1. Add-on codes and modifier 59
    By zaidaaquino in forum Modifiers
    Replies: 2
    Last Post: 02-24-2014, 04:42 PM
  2. modifier 59 with add-on codes??
    By LaSeille in forum Modifiers
    Replies: 1
    Last Post: 01-28-2013, 04:27 PM
  3. modifier and add-on codes
    By krssy70 in forum Modifiers
    Replies: 1
    Last Post: 12-25-2010, 10:00 PM
  4. Add-on Codes and Modifier 76
    By JC Gandy in forum Modifiers
    Replies: 1
    Last Post: 12-29-2009, 05:00 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?

Login

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.