Neurology & Pain Management Coding Alert

Question: Our practice provides sleep lab services, but for business accounting reasons, we need to separate the professional and technical components of the sleep lab services. So when we bill two line items, we're using the same procedure codes for both. Even though we'll append modifier TC or 26, we've been getting denied for duplicate services. What's wrong with our process?

Ohio Subscriber

Answer: The problem could be that your payer is interpreting this as an attempt to bill for duplicate services. If you are submitting the bill on paper, it is possible the payer is not scanning your use of the modifiers, so it looks to them like two identical line items. A call to your payer representative might be in order. In most scenarios, you shouldn't report the service with both modifiers TC (Technical component) and 26 (Professional component) on the same day with the same neurologist's tax identification number. Practices do sometimes separate out the two components, but they are often billed on two different claims and carry different tax IDs. One bill would be for the neurologist's professional component and the second claim for the facility's bill for the technical component.

If the patient is a Medicare patient and either one of the technical or professional components meets Medicare's definition of "purchased," the components need to be reported separately. Additionally, if the services are billed on paper, then separate claim forms should be used.

Clinical and coding expertise for You Be the Coder and Reader Questions provided by Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver.