I am coding in a physician office setting. Should I be appending a the -26 modifier to the new codes 37220-37235. Any help would be appreciated. 
Thanks,
Tracy
Thanks,
Tracy
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Wiki New Vascular Codes
- Thread starter tbanks75
- Start date
I am coding in a physician office setting. Should I be appending a the -26 modifier to the new codes 37220-37235. Any help would be appreciated.
Thanks,
Tracy
Don't append the -26 modifier.
Jessica CPC, CCC
Cyndi113
True Blue
If the cath is done in a hospital setting, then you would append the -26.
TerryFletcherCPC
Guru
Modifier -26 for Cardiology and Peripheral
On the Cardiac Cath codes 93451-93461, yes the modifier -26 is necessary, if you do not own your own cath lab or facility where the procedure is performed. You are providing the "professional component" of the diagnostic service.
On the new Peripheral Vascular codes, these are considered procedures, and not a diagnostic, 2 component service. So you would code them out, without the -26 modifier.
If you are ever in doubt, the easiest way to know, is to go to your Medicare fee schedule, and if the codes are listed 3 times, once with a -26 (professional), once with a -TC (technical), and once with no modifier (global), and you are not the owner of the facility/IDTF/Cath lab where performed, then a -26 is appropriate.
Hope that helps.
Terry
On the Cardiac Cath codes 93451-93461, yes the modifier -26 is necessary, if you do not own your own cath lab or facility where the procedure is performed. You are providing the "professional component" of the diagnostic service.
On the new Peripheral Vascular codes, these are considered procedures, and not a diagnostic, 2 component service. So you would code them out, without the -26 modifier.
If you are ever in doubt, the easiest way to know, is to go to your Medicare fee schedule, and if the codes are listed 3 times, once with a -26 (professional), once with a -TC (technical), and once with no modifier (global), and you are not the owner of the facility/IDTF/Cath lab where performed, then a -26 is appropriate.
Hope that helps.
Terry