Monday, December 13, 2010

Radiology procedure code and modifiers

Procedure Codes and Modifiers

Radiology providers use the Current Procedural Terminology (Procedure ) coding
system. The Procedure manual lists most required procedure codes. This manual
may be obtained by contacting the Order Department, American Medical
Association, 515 North State Street, Chicago, IL 60610-9986.
Radiology Facilities are limited to billing Procedure radiology procedure codes. The
range of codes is 70010 through 79999. Physiological labs are restricted to
the codes listed in their contract with Medicaid.

The (837) Professional, Institutional and Dental electronic claims and the
paper claim have been modified to accept up to four Procedure Code
Modifiers.

Professional and Technical Components

Some procedure codes in the 70000, 80000, 90000, and G series are a
combination of a professional component and a technical component.
Therefore, these codes may be billed three different ways; (1) as a global, (2)
as a professional component, or (3) as a technical component.

• Global, the provider must own the equipment, pay the technician, review
the results, and provide a written report of the findings. The procedure
code is billed with no modifiers.
• Professional component, the provider does not
− 21 (inpatient) own the equipment.

The provider operates the equipment and/or reviews the results, and provides
a written report of the findings. The Radiological professional component
is billed by adding modifier 26 to the procedure code, and should be billed
only for the following place of service locations:
− 22 (outpatient)
− 23 (emergency room - hospital)
− 24 (ambulatory surgical center)
− 32 (nursing facility)
51 (inpatient psychiatric facility)
− 61 (comprehensive inpatient rehab facility)
− 62 (comprehensive outpatient rehab facility)
− 65 (end stage renal disease facility)

• Technical component, the provider must own the equipment, but does
not review and document the results. The technical component charges
are the facility’s charges and are not billed separately by physicians. The
technical component is billed by adding modifier TC to the procedure
code.

1 comment:

  1. If I am not mistaken, AMA and CMS require the use of -26 for professional services. The -21 modifier was for prolonged services and has been deleted.

    ReplyDelete

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