Marguerite Posted Fri 21st of June, 2013 21:41:09 PM
Our provider owns her own equipment and she does the procedure in the hospital, do we need a modifier??? She performs and reads procedure.
SuperCoder Answered Mon 24th of June, 2013 11:59:58 AM
Observe Modifier -26 -TC Exceptions
When reporting either 91010 or 91034 you must remember that you cannot get paid for the entire code unless your office owns the equipment. If your gastroenterologist is using another facility's equipment to perform the manometry you should attach modifier -26 (Professional component) to the CPT code.
For example the physicians at Fisher's practice have their own equipment set up in an ambulatory surgery center. When they perform esophageal manometries or pH studies in that ASC Fisher reports the encounters without any modifiers.
However when the physicians treat Medicare and Medicaid patients at local hospitals Fisher reports the encounters with modifier -26 attached to indicate that her practice only deserves payment for the professional service. These payers do not reimburse her practice for the facility fee she says.
In those instances the hospital will report the appropriate APC code for Medicare or Medicaid patients or will use the CPT code with modifier -TC (Technical component) for the technical component only.