Once you've met your carrier's guidelines for attaching modifier -26 (Professional component) to a radiological code (71010-71555), you're home free, right? Wrong. You now have to report the appropriate diagnosis code.
To ensure proper payment, your pulmonologist has to show medical necessity, and his diagnosis must justify the interpretive test, like an x-ray, says Tamra McLain, CPC, coding manager for HRA Medical Management Inc. in San Diego. For a list of Medicare's acceptable diagnosis codes, check with your local carrier or log on to www.lmrp.net.
Here are some examples of diagnosis codes that support medical necessity at both Blue Cross Blue Shield of Tennessee and First Coast Service Options of Florida:
