Medicare Compliance & Reimbursement

Purchasing power will change the rules for modifiers 26, TC. Reporting modifiers 26 (Professional component) and TC (Technical component) may seem like a breeze, but if you forget to apply modifier 26 on your claim when the physician renders the service in a facility setting, you could be setting yourself up for some serious double-billing accusations. Problem: Coders "don't split up the technical and professional components," says Angela Cook, patient accounts manager with a physician institute in Lecanto, FL. Brush up on your professional, technical component modifier skills and learn what to do when your practice purchases modifier TC. Draw the Line Between Modifiers Certain CPT codes, such as those for myocardial perfusion studies (78465, Myocardial perfusion imaging; tomographic [SPECT], multiple studies [including attenuation correction when performed], 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). In other words: "TC is for the entity that owns the equipment," says Peggy Stilley, CPC, office manager for an Oklahoma University-based private physician practice in Tulsa, "and the 26 is for the professional interpretation." Break Down Modifier 26 If your physician performs a myocardial perfusion study with a facility's equipment, you should use 78465 and append modifier 26 to reflect that he interpreted the findings and wrote the report. Keep in mind: You should not use modifier 26 with procedures that are either 100 percent technical or 100 percent professional. You should use it only on procedures having both components. For example, if a doctor performs an ECG in the office setting, he would report his service with 93000 (Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report). If the physician interprets the same test in the hospital, he'll report 93010 (... interpretation and report only). The first code is a complete service code while the second is limited to the physician's interpretation. Warning: If the physician fails to append modifier 26 and the facility nonetheless bills with modifier TC, the technical portion of the service will have been double-billed, which could lead to accusations of fraud or a demand for repayment from your carrier. Safeguard: Medicare will not pay a physician for the technical component of services provided in a facility setting. In other words, if your claim lists a place of service (POS) as an outpatient hospital (POS 22), this will prevent double-billing from happening. Tackle Modifier TC In the same scenario above, the facility owning the equipment would then report the myocardial perfusion study code 78465 using modifier TC for its portion of the test. Modifier TC indicates to the payer that the facility supplied [...]