Cardiology Coding Alert

Avoid false claims by signifying purchased technical components

If your cardiologist performs and supervises a diagnostic stress test (such as a myocardial perfusion study) using in-house equipment, but another physician does the interpretation, you should not append modifier -26 (Professional component) to the diagnostic test code but use modifier -TC (Technical component) instead.

But that rule can change if your practice purchases the technical component from an independent physician, medical group, or supplier.

A provider that does not own the diagnostic equipment or employ the necessary staff may purchase technical and/or professional components from another supplier and potentially receive reimbursement for the global code, says Marvel Hammer, RN, CPC, CHCO, owner of MJH Consulting in Denver. Differentiate Between Professional and Technical Components

Certain CPT codes, such as those for myocardial perfusion studies (78465, Myocardial perfusion imaging;
tomographic [SPECT], multiple studies, at rest and/or stress [exercise and/or pharmacologic] and redistribution and/or rest injection, with or without quantification), consist of two components: the technical component (modifier -TC) and the professional component (modifier -26).

"TC is for the entity that owns the equipment," says Peggy Stilley, CPC, office manager for Women's Healthcare Specialists, an Oklahoma University-based private physician practice in Tulsa, "and the -26 is for the professional interpretation."

Modifier -26: If your cardiologist performs a myocardial perfusion study with hospital equipment, you should use 78465 and append modifier -26 to reflect that he performed the service, interpreted the findings, and wrote the report.

"You should not use modifier -26 with procedures that are either 100 percent technical or 100 percent professional," says Lisa Center, CPC, quality coordinator with Freeman Health System in Joplin, Mo. "You should only use it on procedures having both components."

Modifier -TC: In the same scenario above, the hospital would then report the myocardial perfusion study code 78465 using modifier -TC for their portion of the test. Modifier -TC indicates to the payer that the hospital only supplied the technical component but not the professional interpretation, Hammer says.

Both -26 and TC: If the cardiologist performs both technical and professional components, he should submit a CMS-1500 form with the CPT code and no modifier to indicate he provided the global procedure, Hammer says.

For example, a cardiologist orders a myocardial perfusion study and interprets and documents the findings. He owns or leases the equipment involved and employs a nuclear tech. In this scenario, the cardiologist performed the global procedure and would submit the CMS-1500 with code 78465. He will be reimbursed for the entire global relative value unit (RVU) amount.

According to Regence BlueCross BlueShield of Oregon, "A 'complete' procedure (that is, professional plus technical component) billed with no modifier attached to the procedure code, is only eligible for reporting and reimbursement when that provider [...]