Radiology Coding Alert

Question: Sometimes our provider will perform an X-ray in-house in addition to reading it. Other times, the patient will be sent to an outside clinic who performs and reads the X-ray. In which case should we be using the technical and professional component modifiers?

Washington Subscriber

Answer: In the second scenario, your provider will not bill out for the procedure at all since the procedure is performed and read elsewhere. When the patient receives imaging in-house, the provider is allowed to bill out using the TC (Technical Component) modifier assuming that the provider owns the equipment. If you work in a hospital setting, for instance, and the hospital owns the imaging equipment, then it will bill out for the TC component and your provider will bill out with modifier 26 (Professional Component) only.

Most providers who work in a hospital setting will have contracts with the hospital in which the hospital will bill out for the TC component each time a patient presents for an imaging procedure. Similarly, the physician who reads the report will bill out using modifier 26.

In the example above, the answer depends on whether or not the physician owns the equipment in use. If the answer is yes, the physician does not need to bill out using any modifier. In this case, they can expect to receive 100 percent reimbursement. If the TC and 26 modifiers are split between two parties, the TC component can expect to receive 60 percent reimbursement and the professional component will receive the remaining 40 percent reimbursement.