Wiki TC vs 26

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mjohnson1

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I'm doing some radiology coding. For example: Pt has a CXR in Michigan, but the provider reading it is in Virginia. Both providers work for the same company. Would the modifier 26 claim get sent to Michigan Medicare or to Virginia? What if the provider is in another country? Please help....:confused:
 
If the company owns the xray equipment and the doctors then there is no modifier. If the xray is done in a facility and and an outside doctor (radiologist) is reading the xray (no matter where they are reading it from in the country or out) The xray is billed with a 26 modifer for the interpretation by the radiologist (specialist) and the facility will bill the same code with the TC for the Technical component because they own the machine. ie 73030-26 and 73030-TC. I work for an orthopaedic group and our doctors own the practice and the x-ray equipment so I bill the xray 73030 with no modifier. If the patient has an xray in the ER then the hospital would bill with the TC and the radiologist that reads that xray bills with the 26. Hope this helps.
 
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