Know How Modifiers 26 and TC in Coding Impact Radiology Billing
Modifiers are the integral part of your radiology coding process as they give extra details to payers and help ensure you get paid correctly. However using modifiers incorrectly is a common reason for lost reimbursement, thus impacting your overall radiology billing outcome. Certified radiology coding experts can ensure codes and modifiers are right, following rules, and leading to getting paid properly for radiology services.
Role of Modifiers in Radiology codes:
Following are the common CPT codes where coding experts use modifiers often-
- 70010-76499 – Diagnostic Radiology (Diagnostic Imaging) Procedures
- 76506-76999 – Diagnostic Ultrasound Procedures
- 77001-77022 – Radiologic Guidance
- 77046-77067 – Breast, Mammography
- 77071-77092 – Bone/Joint Studies
- 77261-77799 – Radiation Oncology Treatment
- 78012-79999 – Nuclear Medicine Procedures
You need to use modifiers to report the payers about the services and procedures have been performed or changed due to specific circumstances.
Modifiers are really important in radiology coding. They give extra details about the services, making sure your overall radiology billing method is right. They’re added to CPT codes and tell things like where the service happened, if there were multiple procedures, or if it’s about the professional part of the service.
Frequently used modifiers in radiology coding:
26 and TC are the modifiers that you need to use very frequently in radiology coding.
Let’s know more about these two modifiers.
Professional component (26): Some procedures have both a professional and a technical part. Modifier 26 shows the professional part and is added to the code when a radiologist only does the image reading, without using the equipment. This often happens when the radiologist looks at images for a place like a hospital or doctor’s office that owns the machines and staff but needs the radiologist to read and write reports.
Technical Component (TC): The technical component includes all the stuff needed for the procedure, like equipment, staff, and expenses. When only the technical part is billed, TC is added to the CPT code. TC shows only the charges for the facility when there’s a cost to the place where the procedure happens.
For example, let’s say a provider has an office with an X-ray machine. They hire a professional for the test but send the images to a radiologist to read and report on:
The provider’s office bills for the radiology service with a TC modifier.
The radiologist bills for reading and reporting on the same service with a 26 modifier.
When not to use modifier 26: AAPC says don’t use the 26 modifier in these cases:
If a doctor does both the professional part (supervision, reading, report) and the technical part of a service, they should bill for the whole service – the procedure code without TC or 26 (like an X-ray of a broken bone in the orthopedic surgeon’s office).
Don’t use modifier 26 if there’s a specific code just for the professional part of a service.
Don’t use modifier TC if there’s a specific code just for the technical part, like 93005 Electrocardiogram; tracing only, without interpretation and report.
Modifier 50: Modifier 50 means a procedure done on both sides of the body. “Both sides” means right and left, not front and back (AP/PA and lateral). Bilateral procedures done in the same session, like:
- Right knee – Left knee
- Right kidney – Left kidney
Sunknowledge: The perfect radiology billing partner
If you are feeling overwhelmed with all the nuances of using proper radiology codes and a modifier, Sunknowlede has your back. Our expert radiology billing team knows how to use accurate use of radiology codes and modifiers. For further details, our team is ready to assist. Arrange a meeting to explore how we can enhance ROI. We excel in providing authentic value and reliability
