Wiki 36252 modifier needed?

[CPCCODERII]

While doing some research for CPT 36252 I came across a paragraph in the CPT Reference Guide for cardiovascular coding 2012 and on page 85 it states that when billing 36252 you should append a 26 modifier. I am questioning if we need to be adding this since we are billing the professional component of our physician's services? If anyone has any further information on this, I'd appreciate it. I would also appreciate any references you may have regarding this.

Thank you in advance!

 

[jewlz0879]

Yes, you should use a modifier 26 if you want to capture the professional component of 36252. We perform these in the hospital and always use mod -26 since we are unable to bill for the technical components like the catheter and ect; the hospital will bill for that.

HTH

 

[CPCCODERII]

Thank you for your response I looked on the Medicare fee schedule and it doesnt list a 26 modifier as an option for this code (we are WPS IA Medicare). Also our internal edit system gives us an edit that states:

"The procedure selected does not allow for modifiers TC and/or 26. Medicare and many other payers do not allow the use of the tech/prof components with this CPT code."

But I can see why the 26 would now be needed for this code, as it has radiologic supervision and interp. So not sure why Medicare does not list this code correctly? Any thoughts?

 

[jewlz0879]

I totally lied. My aplogies. Not sure where my mind was when I answered this. LOL. Wow. We don't bill with the -26 either. I read what I wrote here just a min ago and was like, 'what am I saying.' Switching gears too much I suppose!

 

[CPCCODERII]

Phew! Good, then we have been billing these appropriately! I saw that in the CPT reference guide and had an "Oh great we've been doing it wrong!" moment! LOL Thanks again for your help!!