Practice Management Alert

Question: We commonly report radiology codes for services such as chest x-rays without a modifier when our physician only performs the interpretation. In the past we have received appropriate reimbursement for only the professional component because the carrier paid the hospital that performed the x-ray for the technical component. Lately, however, we have received some full payments on these claims, even though we only deserve professional-component pay. What's going on?


Virginia Subscriber

Answer: Filing a radiology service claim without a modifier indicates that your physician performed both the professional and technical components. Reporting the professional component of x-ray services without modifier -26 (Professional component) is a dangerous practice considering today's various radiology clinic arrangements. Many times there is no way for the carrier to tell whether the claim is truly from a hospital setting or from a separate imaging center associated with the hospital. So if you file a claim with no modifiers, you risk securing inappropriate payment for your facility's services.

Generally, the hospital that performed the patient's x-ray will bill the code - such as 71010 (Radiologic examination, chest; single view, frontal) - with modifier -TC (Technical component) to indicate it is billing for the equipment, room charge, film and radiologic technician, but not for the physician's interpretation. If the physician who renders the interpretation is with a separate professional group and is not a hospital employee, you should report the service with modifier -26 to obtain his proper share of the reimbursement.

Check first: The carriers that paid you appropriately in the past probably didn't require a modifier. For instance, many carriers don't want to see modifier -TC on claims. The best way to obtain proper pay is to call your carriers and ask what modifier they prefer. 

The answers to the Reader Questions were provided and/or reviewed by Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J.