Wiki Question about TC and 26 modifiers

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ccoleman822

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Oxford, MS
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Hey all,
I have a quick question about the TC and 26 modifiers. We have an offsite clinic that we rent the X-ray machine to take xrays. We are trying to make our clinic flow better and I was wondering if it was possible to let the pt's who need the xrays to come in a day before to take them. If we do this we would add the modifier and add a TC mod, nobody else would charge for the xray that day. Then when they come in for their appointment the next day we add the 26 mod since the provider would then interpret the test. Is this correct and can we even do this or do we just charge the xray on the visit date withiout mods.

Any help would be appreciated,

Thanks,
 
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My main concern would be - Who is ordering and when is the x-ray being ordered? For example, are these patients where the clinician said "Return in 3 weeks for a repeat x-ray" or a patient first presenting with foot pain and you need to evaluate if there is a fracture? In the second scenario, who is determining an x-ray is needed, of what body area, how many views, diagnosis, etc if the patient wasn't seen first?

Per this CMS article, if you are billing global, it appears you may bill either the date performed or the date interpreted.
"When billing a global service, the provider can submit the professional component with a date of service reflecting when the review and interpretation is completed or can submit the date of service as the date the technical component was performed."
 
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csperoni said:
My main concern would be - Who is ordering and when is the x-ray being ordered? For example, are these patients where the clinician said "Return in 3 weeks for a repeat x-ray" or a patient first presenting with foot pain and you need to evaluate if there is a fracture? In the second scenario, who is determining an x-ray is needed, of what body area, how many views, diagnosis, etc if the patient wasn't seen first?

Per this CMS article, if you are billing global, it appears you may bill either the date performed or the date interpreted.
"When billing a global service, the provider can submit the professional component with a date of service reflecting when the review and interpretation is completed or can submit the date of service as the date the technical component was performed."
Click to expand...
You actually answered my question right there with that link....Thank you very much.
 
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I have the same question. I have a provider who is ordering the xray to be done. The patient is going to get the xray done, they are to bill with the TC and we were told to bill with the 26 professional component. I am getting all denials stating this is inclusive in the office visit. I have never had this problem until recently. I am just wondering if you are too? I have looked at the articles above and am still a little confused. Thanks for your help.
 
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We haven't been having that problem. 1. It could be that whoever is billing the TC is billing the whole X-ray themselves or 2. The E/M charge may be to high. If they do a x-ray the same day as being seen, from my understanding, that cannot go into the determination of the E/M charge. I usually have to lower my visit to a lvl 2 visit when this happens and seems to be working for me.
 
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I have billed a level 3, however, it should be a level 3 so I don't want to lower this just to be paid for an xray. I will keep appealing and hope they correct this. Thank you for your help!
 
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