Wiki Facility billing with TC/26

[LindaEV]

I'm not experienced in outpatient/facility coding but need help with a question.

How do you bill for procedures when there is a TC/26 involved? For example, a specialist see's a pt in out outpt clinic and orders an EMG. HE reads the EMG. The hospital billing department needs to bill the specialists charges on a 1500 to Medicare Part B, and bill the facility charges on a UB to Medicare Part A.

How should these claims be submitted? Do we use a 26 for the professional fees and a TC for the facility fee?
I have someone saying the hospital bills the code without any modifier, because Medicare will only pay the TC anyway to the facility.Thanks for any help

Linda

 

[kevbshields]

The EMG will be paid on the facility side under Medicare Part B and though it is only charging for the TC portion, on the UB the "TC" modifier is omitted. The proper revenue code would point to proper charge.

 

[sphillips79]

We do this exact billing at our facility, we bill the tc comp on a UB04 no modifier and the PC on a 1500 with modifier 26, you do not need to add the TC modifier to the UB because they know it's the technical already.