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Cardiology Coding Alert

Reader Questions:

Confront This Modifier 26 Advice

Published on Mon Jul 28, 2008

Question: I have heard conflicting advice about whether modifier 26 is necessary when we report wall motion and ejection fraction add-on codes. Are there certain instances when we should use this modifier?Alabama SubscriberAnswer: When your physician interprets wall motion and ejection fraction studies but your practice did not furnish the technical portions of the service, you should append modifier 26 (Professional component) to the appropriate add-on code.The myocardial perfusion test's technical portion, which the facility will report, includes payment for the technical staff who administered the wall motion study, utilities and supplies. Physicians typically bill the professional component only in hospital settings or when an outside facility administered a test and someone requests their interpretation. Modifier 26 tells the insurer that you are billing for only the cardiologist's interpretation.
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