Wiki Tc and 26 componts

[dalanicks@aol.com]

Hi I have a question if anyone can help would be great, does the professional and technical component have a time frame as to when it has to be billed, and where would I be able to find information on that,


THANK YOU

 

[ellzeycoding]

Depending on the carrier, there may be time frame limitations as to when the claims can be initially filed from the original DOS.

The time frame for Medicare claims is 12 months

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/mm7270.pdf

Now there is a second part of this question. Dates of Service.

The Technical Component DOS should be billed on the date the specimen was obtained.

Medicare had released a bulletin last September, later rescinded in October, attempting to make a policy that the DOS of professional component was the date of interpretation. For -26, this often occurs days later, making global billing impossible. Since they rescinded the national policy, they left it up to the individual contractors to come up with their own policy. Here is an chart from an old McKesson article that breaks it down by state.

For example, here is Novita's policy...

Example policy from Novitas:

“The technical component is billed on the date the specimen was collected. This would be the surgery date. The professional component is billed on the date of service the physician provided the interpretation and report of the pathology service. If these occur on different dates, these must be billed with different dates of service, and modifier TC for the technical component and the modifier 26 for the professional component.

Source: https://www.novitas-solutions.com/webcenter/portal/MedicareJH/pagebyid?contentId=00158101

 

[dalanicks@aol.com]

thank you ellzeycoding ! I appreciate it