When can i use modifier 26

Modifier 26 is appended with global billing codes, when physician performs only the professional component service supervision and interpretation. Certain services provided to the patient are a combination of both professional component and technical component also called as global procedure code.

In this case the professional and technical component are not reported or billed separately to the insurance company. If we are billing only professional component, then we need to bill the particular procedure code by appending with modifier If only reimbursing for technical component, then we need to bill the particular procedure code by appending modifier TC.

If the surgery performed along with radiological guidance, please check under that particular surgery code in CPT book whether to report that radiological supervision and interpretation separately or not. Let us see with both scenarios:. For example: Please check the surgery code in the CPT book, under that CPT code the parenthetical note states for radiological supervision and interpretation, see , , , However, still many of us have a lot of difficulty in understanding the use of these modifiers.

I myself initially was struggling to use these modifiers. Modifiers are always little tricky to apply with CPT codes. Modifiers play an important role in modifying the procedure and changing the dollar value of the procedure code. We have already learnt previously about how to use 58 and 78 modifier , now we will learn more about 26 and TC modifier.

Read also: Learn how to use 25 and 27 modifier. If you have coded diagnostic procedures, you will be very familiar with 26 modifier. This modifier is used very frequently in diagnostic radiology CPT codes. For physician side or professional services, one who reads and interprets the report usually has to assign 26 modifier.

Technical Component TC is assigned when the physician does not own the equipment or facilities or employs the technician. In short, 26 modifier is assigned to pay for the physician services only. While TC modifier is assigned for the facilities used or the equipment used to perform the procedure.

Read also: Secret tips for coding 76 modifier. For 26 modifier, the physician supervises and interprets the results. For example, a boy fall and get some injuries in hand and then he goes to the physician office, the physician thinks he has fracture and wants and X-ray. The physician does not have equipment for X-ray. Therefore, the boy is sent to urgent care department to take an X-ray.

Now, the boy returns to the same physician. The physician interprets the result from the films obtained through X-ray machine. Now, here you can understand very well, how the procedure worked. So, now we have to bill the procedure for both the physician and the urgent care department. Read also: Awesome tips to become Certified Professional Coder. Remove Confusion about TC component. Since CPT codes are intended to represent physician and other healthcare practitioner services, CPT does not contain a coding convention to designate the technical component for a procedure or service.

For example, Medicare established the -TC modifier for reporting the technical component. Procedure Coding: When to Use the Modifier Curious if you have the right staff in the right roles? Wondering how you can keep your staff incentivized and focused on the patient experience? Check out our free e-book, Staffing in the New Economy.

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