That is not correct, we should always remember that unless there are parenthetical notes or guidelines spelling it out, nothing is ever "understood" or "assumed" when it comes to coding and billing. If a procedure that has both a professional and technical component is billed without a modifier, it is considered global. The DRG can't pay only technical because the fact that something was done inpatient doesn't necessarily mean that the radiology isn't outsourced somehow. Many hospitals have an outside radiology company doing the interpretation and report, so regardless of the status of the patient (in or out), the hospital can only bill technical. As far as policies/rules go, I would with the modifier descriptions in CPT/HCPCS. The description for modifier -TC in the HCPCS book is pretty detailed. Otherwise I would just argue that it's correct coding to use modifiers when they are appropriate to ensure proper reimbursement. That's just something that every coder knows, it's not a big secret. Does the TPA employ any coders? If so they should know better, and if not then you may have leverage there, because you're the subject matter expert when arguing coding policies and guidelines. Hope I could help. Anybody else wanna weigh in?
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