In medical coding, modifiers are used to provide additional information about a medical service or procedure. (Meaning=You are changing the CPT code description in some way)
Chest X-ray Ordered. Equipment owned by MD office, to rule out pleural effusion. The physician interprets the chest films and documents the finding.
71046
71046-26
71047-TC
71047-26
Answer to the question below.
Modifier TC is used to indicate that the service or procedure being coded was performed in the Technical Component (TC) only. This means that only the technical aspect of the service or procedure was provided, and no professional component was involved. For example, if a diagnostic imaging procedure is performed in a hospital setting, the hospital would use modifier TC to indicate that only the technical aspects of the procedure, such as the use of the imaging equipment and the interpretation of the resulting images, were provided by the hospital.
Modifier 26 is used to indicate that the service or procedure being coded was performed by a qualified non-physician provider, such as a physician assistant or nurse practitioner. This modifier is often used when a non-physician provider has performed a portion of a service or procedure that would normally be performed by a physician. For example, if a physician assistant performs a portion of a surgical procedure under the supervision of a physician, the physician assistant would use modifier 26 when billing for their services.
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Simple example could be 71045-TC Chest X-ray. TC would account for the cost of supplies and staff to perform the X-ray. The MD who interprets the result of the X-ray submits 71045-26 appended.
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Answer choice A is correct.
2 views taken of the chest (AP and Lateral), eliminating C and D. The films were taken at MD’s office by the MD who owns the equipment and interpreted films indicating a global service was performed so no modifiers (26 or TC) will be added to radiology service.
Modifier 26 is reported when the MD does not own the equipment, but provides supervision and interpretation of report, and is performed in the radiology department at a hospital or an outpatient hospital facility.
Modifier TC is added to a radiology service by the hospital or outpatient facility noting the facility owns the equipment that is used for radiological service.
In the scenario it is noted that the MD owns the equipment and interprets the films making a global code 71046 a correct answer.
References for these modifiers can be found in the Current Procedural Terminology (CPT) codebook and the Medicare Claims Processing Manual. The CPT codebook is published by the American Medical Association and provides detailed information on the codes used to describe medical procedures and services, including modifiers. The Medicare Claims Processing Manual is published by the Centers for Medicare and Medicaid Services and provides guidelines for processing Medicare claims, including the use of modifiers.
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