Oncology & Hematology Coding Alert

Question: I need to bill only the professional component for 77336 and 77370 with place of service (POS) code 22 and I keep getting denials on billing the professional component saying the service is only applicable for TC. How should I bill this?x`

AAPC Forum Participant

Answer: You are being denied for two reasons. First, modifiers 26 (Professional component) or TC (Technical component) are not listed in the modifier columns for 77336 (Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy) or 77370 (Special medical radiation physics consultation) according to the Medicare Physician Fee Schedule (MPFS) database at https:// www.cms.gov/medicare/physician-fee-schedule/search.

That means neither code separates out into a technical or professional component. Per the MPFS database, the codes have a professional component/technical component (PC/TC) indicator of 3, which makes them technical component-only codes and not able to be modified using 26 or TC modifiers. As CMS says, the 3 indicator “identifies standalone codes that describe the technical component (i.e., staff and equipment costs) of selected diagnostic tests for which there is an associated code that describes the professional component of the diagnostic tests only.”

Second, technical component-only codes are always billed with POS 22 (On campus-outpatient hospital), and the charges go on the facility bill. The physician cannot bill for POS 22 services themselves; they can only bill for services when they are provided by the physician in the physician’s own office (i.e., the services are billed with POS 11 (Office)).