Resolved Radiology billing

[JanetA_51595]

Question for anyone billing for Radiologist
My Radiologist is doing outside readings for the local hospital- I know that is mod 26 on his reads
If he is performing the test on site and also doing the reading how so I bill that and with what modifer?
I want to do it correctly since its at the hospital and he doesn't own the equipment

 

[Lori]

• When billing both the professional and technical component of a procedure when the technical component was purchased from an outside entity; the provider would bill the professional on one line of service and the technical on a separate line.

If, however, a physician provides both the professional component (supervision, interpretation, report) and the technical component (equipment, supplies, and technical support) of a service, that physician would report the global service — the procedure code without the TC or 26 modifier.

When to Apply Modifiers 26 and TC

Understanding the appropriate use of modifiers 26 and TC is key to filing clean claims and avoiding denials for duplicate billing.

www.aapc.com

 

[JanetA_51595]

My confusion is this: example is cpt 32408 Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed
The Provider is not an employee of the hospital and they own the equipment
he is doing outside reads for the hospital
This charge was denied when billed with mod 26 ( in Find a code there is no modifiers listed)
How do I bill it if he is the performing and reading

 

[Alicia]

Was it denied d/t the -26 or was there more then one lesion? This code did change for 2021.
I found a couple resources for you:

https://www.cms.gov/files/document/r10667cp.pdf

PERCUTANEOUS NEEDLE CORE BIOPSY LUNG OR MEDIASTINUM - StreamlineMD

What’s New BEGINNING JANUARY 1, 2021

streamlinemd.com

Coding Changes That Will Impact Radiology Practices In 2021

The big news in Current Procedural Terminology (CPT)® revisions for 2021 is the overhaul of the Evaluation and Management (E/M) section, reducing documentation requirements and introducing new rules for determining the level of coding. These changes will affect interventional radiologists and...

info.hapusa.com