Wiki 26 modifier on a surgery code??

[avrilw]

Our facility bills out a claim for the facility fee on our surgeries and then we bill a separate professional claim for the physician fees. Our facility coder is telling us we need to bill a 26 modifier on our professional claim for procedure 44970 (Laparoscopic Appendectomy). Is this correct? I have never billed 26 modifiers on surgical codes before. Can someone please provide some insight? Thank you!

 

[thomas7331]

That is not correct - surgical procedures do not have technical and professional components. If you look up any code on the CMS website under the physician fee schedule, it will tell you the PC/TC indicator, which designates whether or not the code includes these components. CPT 44970 does not have a professional component and billing that code with modifier 26 would be an error.

 

[avrilw]

thanks

Thank you thomas! I thought I was going crazy!