Wiki Billing Modifiers 26/TC.

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chavera

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I work for a small family practice and we are having difficulty understanding if our providers should be appending modifiers 26 or TC to diagnostic studies that are done in the office. For example the doctor orders an echocardiogram to be done on a patient and we have a person who comes in to perform the test. The interpretation of the results is done by another provider outside our office. After the results are confirmed they are then faxed over to our office and the patient comes in for a follow up on the results to be read by our provider. If our provider didn't do the interpretation of the test and didn't perform the test, but it was only done in our office would he bill the diagnostic study with either modifier 26 or TC?

Thanks,

Raquel
 
You would not use the 26 as that is for the provider that provided the interpretation, going over the results with the patient is part of the E&M, you would use the TC only if you own the equipment, if you simply provide the office space for a company to have their tech and equipment perform this test then they will bill the TC. Meaning there is nothing for you to bill outside of the E&M.
 
Billing Modifier 26/TC.

So what is our doctor suppose to bill if he is the one who ordered the test to be done? The provider who interprets the results for our provider does not bill anything nor does the tech who comes in to perform the study, so what if the doctor is in the office while the study is being performed then can he bill for it?

Thanks
 
If the doctor who is interpreting the tests isn't billing anything, he is definitely losing money. Does your office pay him under contract? If that's the case, then your office can bill global if you also own the equipment. If you don't own the equipment, then your office can bill with the 26 modifier.
 
chavera said:
So what is our doctor suppose to bill if he is the one who ordered the test to be done? The provider who interprets the results for our provider does not bill anything nor does the tech who comes in to perform the study, so what if the doctor is in the office while the study is being performed then can he bill for it?

Thanks
Click to expand...

So it would appear from your post that your office pays the tech and interpreting physician for their services. Then you bill the global test code.

I would clarify that this is the case before proceeding, in case the other providers are billing for their services.
 
A provider can not code a test by order only. It has to be performed in a premises and on a patient. who performs that test can only bill the services, may be interpretation or technical.

Thanks
Rajesh Verma
 
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