Ophthalmology and Optometry Coding Alert

Question: My colleague and I are having a discussion. She says that we need a modifier on all X-ray codes regardless of the situation. I think, however, that there are some instances where you don’t apply a modifier to an X-ray code. We perform X-rays here and there but not daily, so we aren’t sure if we’re missing something. Can you advise?

Kansas Subscriber

Answer: You’re right on this one. While many X-ray claims get filed with modifier 26 (Professional component) appended, not all of them require the modifier.

The decision depends on ownership of the X-ray equipment. If your physician, or the facility where your physician works, has its own X-ray equipment, you’ll report the code without any modifiers. For example, if the physician conducts a four-view orbital X-ray, you’d report 70200 (Radiologic examination, orbits, complete, minimum of 4 views) with no modifier.

If, however, the physician performs the same X-ray using, say, a hospital’s X-ray equipment, you’d report 70200 with modifier 26 appended to indicate that you are only coding for the physician’s work, not the X-ray equipment use. Then, the hospital would report 70200 with modifier TC (Technical component) appended to indicate that it is only coding for the X-ray equipment use, not the physician’s work.

Result: Both the facility and the physician will split the payout for 70200 as both had a hand in providing the service.