Appending modifier TC Technical component indicates that only the technical component of a service/procedure has been provided. Generally, the technical component of a service/procedure is billed by the entity that provides the testing equipment.
Physicians providing services for Medicare patients in a hospital or facility setting cannot claim the technical portion of a procedure. Under the diagnosis-related group (DRG), the hospital/facility receives payment for the technical component of Medicare inpatient services. Similarly, Medicare rules require that payment for non-physician services provided to hospital patients (such as the services of a technician administering a diagnostic test) are made to the hospital.
Just as there are codes that describe professional-only services for Medicare, so are there codes describing technical component-only services (e.g., 93005 Electrocardiogram; tracing only, without interpretation and report).
A “global” service includes both the professional and technical components of a single service. When reporting a global service, no modifiers are necessary to receive payment for both components of the service.
The technical component of a diagnostic service/procedure accounts for equipment, supplies, and clinical staff (such as technicians). Payment for the technical component also includes the practice expense and the malpractice expense. Fees for the technical component generally are reimbursed to the facility or practice that provides or pays for the equipment, supplies, and/or clinical staff.
Procedures/services that may include both a professional and technical component are found commonly within the “Radiology,” “Pathology and Laboratory,” and “Medicine” sections of the CPT® codebook.
Separate payment may be made for the technical and professional components of a procedure if, for example, a clinic provides the technical component of a service/procedure, while an individual physician performs the professional component. In such situations, each provider must submit a claim and bill only for the service performed.
To identify professional services only for a service/procedure that includes both professional and technical components, append modifier 26 Professional component to the appropriate CPT® code, as instructed in CPT® Appendix A (“Modifiers”). Note that modifier 26 is appropriate when the physician supervises and/or interprets a diagnostic test, even if he or she does not perform the test personally. Do not append modifier 26 if there is a dedicated code to describe only the professional/physician component of a given service (e.g., 93010Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only).
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Mutually exclusive edits identify code pairs that Medicare has determined, for clinical reasons, are unlikely to be performed on the same patient on the same day. For example, a mutually exclusive edit might identify two different types of testing that yield equivalent results. When two mutually exclusive services are submitted on a claim, only the service of lesser value will be reimbursed.
Table 1 provides a short sample of Column 2 edits for CPT code 12001 (Simple wound repair, up to 2.5 cm). CPT code 64450 (peripheral nerve/branch block) in Column 2 is considered an integral part of the Column 1 service, but a modifier is appropriate to override the CCI edit for 64450 in combination with 12001 if the block is for a separate session, separate injury or separate anatomical area.
HCPCS Level II code G0168 (Dermabond repair) is also considered an integral part of the simple laceration repair 12001 and a modifier is allowed to bypass the NCCI/CCI edit. Although you would not typically report both 12001 and G0168 for the same beneficiary on the same date of service, it is clinically conceivable that you would repair 2 distinct wounds on a single patient, one utilizing Dermabond and a second a simple repair utilizing sutures.
Procurement of the saphenous vein graft is included in the description of the work for 33517-33523 and should not reported as a separate service or co-surgery. Procurement of the artery for grafting is included in the description of work for 33533-33536 and should not be reported as a separate service or co-surgery, except when an upper extremity artery (e.g., radial artery) is procured. To report harvesting an upper extremity artery, use 35600 in addition to the bypass procedure. To report harvesting of a femoropopliteal vein segment, report 35572 in addition to the bypass procedure.
+33517 – Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft (List separately in addition to code for primary procedure)+33518 – 2 venous grafts (List separately in addition to code for primary procedure)+33519 – 3 venous grafts (List separately in addition to code for primary procedure)+33521 – 4 venous grafts (List separately in addition to code for primary procedure)+33522 – 5 venous grafts (List separately in addition to code for primary procedure)+35523 – 6 venous grafts (List separately in addition to code for primary procedure)medical coding training
Related to past, present, or future health of client.
Regarding client’s caretakers, family members and friends.
Created or received by you or the agency with which you
are volunteering. Related to healthcare received or Shared to obtain payment.
Is created, kept, filed, used or shared
Is written, spoken, or electronic
A person’s name, address, birth date, age, phone
fax numbers, e-mail address
• PHI is individually identifiable information that is maintained or transmitted in any form.
• PHI is any information, verbal or recorded, relating to the health, healthcare or payment for health care provided.
• The information does not have to be created by your organization to be considered PHI.Medical coding training online
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