Wiki Modifiers - across any issues

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JRAINERI12

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Hello.

I was curious to know if anyone has come across any issues with the TC or -26 modifer when billing Medicaid or anyone else.

Or with 94762-26?

Thank you
Jennifer
 
Thank you so much for your response. I work in the billing department for a Pulmonary group and we do Inpatient/Outpatient billing.

BC and others have been denying us when we bill 94762-26. We looked in the CPT book after we read your response and got totally confused. :confused:

We want to be paid for the professional component only. If we bill 94762 w/o the -26 are we billing globally?

Thank you so much
Jennifer
 
When I look up that code, 94762, it shows a payment indicator of 3 which means Technical Component Only Code. That cpt code does not have a professional component attached so you cannot bill it as 94762-26.
 
Thank you. I apologize if I am being redundent, so this is a TC code only? Meaning you can only use it if you are doing the technical part?

Really, this is a great place, we really truely appreciate your responses! :eek:
 
Help !

Just researching this code myself. Is the answer to the question that this is strictly a TC modifier for 94762? If yes, the doctor interprets the result that is performed in a hospital setting, why isn't the 26 allowed? This is then a global code? Thanks for the help and any documentation to support it!
 
For codes that have both a technical and professional component built in to them, you use either TC or 26 to "reduce" the code's reimbursement to the appropriate amount based on which part you are billing for.

Sometimes, CPT creates distinct codes for each component, meaning each code is all professional work, or is all technical work, with the "TC" or "26" already being built in or implied within the code. 94762 is one such code. The entire code is for the technical work only of overnight monitoring, meaning that the only way it can be billed at all is for the physician to own the equipment/incur the technical costs associated with the test. If the physician does not own the equipment, this code can not be billed by the physician.

Seth Canterbury, CPC, ACS-EM
 
modifier

Some non medicare payors do not recognize the 26 or the TC modifiers. Medicare does recognize these but you do have to be careful and follow the insurance guidelines
 
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