Even though a single CPT code characterizes most radiology services or processes, they are divided into two parts: a professional element and a technical element. The physician provides the professional component, including monitoring, interpretation, and a full report. CPT Appendix A, Modifiers, tells you to attach modifier 26 to the relevant CPT code to claim only the professional element. The scientific component of service involves providing all exam-related equipment, materials, staff, and prices. Append modifier TC to the appropriate CPT code to claim only the technical elements. Modifier 26 and Modifier TC are one-of-a-kind coding tools utilized in various situations.

It’s simple to become confused when trying to recall when to use these modifiers and maintain the elements of a procedure clear. In this post, we will look at the most typical usage of modifiers 26 and TC and describe when and how to utilize them properly to clear up some of the misunderstandings. Knowing how to use modifiers 26 and TC correctly is essential for filing clean claims and preventing denials for repeated billing.

The 26 modifier is a coding tool in billing and coding. A modifier informs payers about the precise labor during a patient’s therapy. When modifier 26 is required, this principle is carried a step further. Modifier 26 can only be used for treatments that involve a “professional component.” As a result, understanding when to utilize the 26 modifiers correctly frequently generates difficulty among billers.
To assist in clearing up some of the uncertainty, this article will look at some of the most popular uses of modifier 26 and when and how it is used properly.

When to use Modifier 26:

Polysomnography is performed on a patient by a sleep clinic. The test results are interpreted by a physician who is not affiliated with the sleep center institution. To express her polysomnography assessment, this physician would add modifiers 26 to 95811.

A pregnant woman arrives in the emergency room with early labor. The ultrasound conducted at the hospital identifies pregnancy abnormalities. The patient is referred to a specialist for additional evaluation, and the hospital imaging data is submitted along with the patient for assessment. Because the expert reviews and interprets the ER ultrasound, modifier 26 on the ultrasound CPT would indicate their viewpoint service of the scan.

A treating physician requests a check from a third-party laboratory for his patient. The pathologist from the lab then delivers a written explanation to the attending physician. In this situation, the pathologist might bill the operation 83020 with a modifier 26 indicating their assessment of the test results.

Inaccurate use of modifier 26

To illustrate inappropriate use, in the preceding example, the treating physician cannot charge 83020-26 after reviewing the pathology report because the pathologist has already evaluated the result. The treating physician may add her judgment in her medical decisions, but she should not charge for it individually.

Summary

Understanding how to utilize modifier 26 correctly and appropriately will be critical to submitting clean claims and avoiding denials for repeated billing. Note that the testing facility must also submit a claim for reimbursement of the technical element. That is why providing modifier 26 for the interpreting doctor on the same code will be crucial in proving your provider’s distinct role in the treatment provided. As a result, appropriately reporting the 26 modifiers lessens the possibility of inaccurate payer denials and delays in payment. We offer the necessary knowledge and ability to guarantee that your billing accurately captures all services, resulting in more efficient and effective collections. Don’t hesitate to contact us for additional information about billing and coding!