Good Afternoon. I am slated to take my CPC exam in 3 weeks and I am still struggling with when to assign the above 2 modifiers. Can someone give me an easier way to understand when and under what scenarios to assign these? I know one is for the Dr. and the other theTech, and sometimes for the Dr., who physically operates the equipment. After that, everything is clear as black mud...
I would appreciate any help. I have been working cases and those needing -26 and TC are frequently missed.
Thanks.
Modifier 26 is used to indicate that a physician interpreted the results of a test but did not perform it. It can be used for most radiology codes, including ultrasounds, x-rays, CT scans, magnetic resonance angiography, and magnetic resonance imaging. It can also be used to bill only the professional component of a test or to report a physician's interpretation of a test.
Here are some examples of when modifier 26 might be used:
- A physician not associated with a sleep center interprets the findings of a polysomnography test
- A specialist reviews and interprets an ER ultrasound
- A pathologist provides their written interpretation to the attending physician
Modifier 26 should be appended to the appropriate CPT code and reported in the first modifier field. It's only appropriate in certain places of service (POS), including: Hospital inpatient (POS 21), Hospital outpatient (POS 22), Emergency Room (POS 23), and Off Campus-Outpatient Hospital (POS 19)
Modifier TC is used in coding scenarios when only the technical component (TC) of a procedure is being billed. It can be used in a variety of situations, including when:
- A physician performs a test but doesn't interpret it
- A patient is in a covered Part A stay in a skilled nursing facility (SNF)
- The technical component was purchased from an outside entity
- A procedure has a "1" in the professional component (PC)TC field on the Medicare Physician Fee Schedule Database (MPFSDB)
For example, if a hospital owns the urography machine used in a procedure, the facility would bill 74420 with Modifier TC. Another example is if a freestanding radiology clinic performs a chest X-ray and a physician not employed by the facility interprets the films, the clinic would append Modifier TC to the chest X-ray code, while the physician would submit a claim with Modifier 26.
Modifier TC should be reported in the first modifier field. When coding two pricing modifiers that include either a professional or technical component (26 or TC), always use the 26 or TC first, followed by the second pricing modifier.
