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X-rays

Annette Posted Tue 07th of February, 2017 10:10:19 AM
Blue Cross is denying all of my x-ray charges this year saying it is missing a modifier. Years ago we used 59 and then were told not to use that anymore. What modifier do I need to use? And do I also need to use a modifier then with the office visit? Thanks!
SuperCoder Answered Wed 08th of February, 2017 07:40:26 AM

Hi Annette,

Modifiers that you need to append are XE, XS, XP, XU (effective January 1, 2015). These modifiers were developed to provide greater reporting specificity in situations where modifier 59 was previously reported and may be utilized in lieu of modifier 59 whenever possible. (Modifier 59 should only be utilized if no other more specific modifier is appropriate). Please find the link below for more details.

https://www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/downloads/modifier59.pdf

Hope it Helps.

Annette Posted Thu 09th of February, 2017 10:02:10 AM
I didn't use any modifier last year. I looked up those modifiers and none of them seem to be our situation. The x-ray was done in our office and then reviewed by the physician. They are being denied because "the modifier required is missing." Any other suggestions?
SuperCoder Answered Fri 10th of February, 2017 05:17:09 AM

For x-ray, check with modifier TC (Technical component) for office and 26 (Professional Component) for physician. Thank you.

Annette Posted Fri 10th of February, 2017 08:35:55 AM
We did the x-ray and read it. Do I use both modifiers? Thank you for your help!
SuperCoder Answered Mon 13th of February, 2017 07:26:47 AM

Hi Annette,

Here is the explanation as to how and when we use TC, 26 or no modifier with our codes.

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. 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., 93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only).

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.

For example: Code 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete includes both a technical component (the ultrasound machine, along with necessary supplies and clinical staff to support its use) and a professional component (physician supervision, interpretation, and report). If pelvic ultrasound is performed at the physician’s office, either by a physician or a technician employed by the practice, report 76856 without a modifier because the practice provided both components of the service. Hope it helps.

Annette Posted Mon 13th of February, 2017 11:16:57 AM
Ok. Thanks. But you gave me examples of other procedures. According to blue cross, an x-ray now needs a modifier. I was billing it with an office visit and no modifiers. 99213 and 72100. So since the physician both took the x-ray and interpreted it, I would use modifier 26?
SuperCoder Answered Tue 14th of February, 2017 05:22:32 AM

Hi Annette,

Ideally to report the complete procedure (i.e., both the professional and technical components), submit 72100 without a modifier, "global service with no modifier". However, your claim is getting denied by blue cross saying "missing a modifier", we will bill code twice. 72100-TC and 72100-26 in two different lines in same claim form as physician both took the x-ray and interpreted it.

Annette Posted Tue 28th of February, 2017 15:45:56 PM
Hi, I don't know what else to do. Blue cross also denied the TC and the 26. I did it on 2 lines. They are the only insurance insurance denying it. Others are still paying without the modifier. Same denial code: 4 "The procedure code is inconsistent with the modifier used or a required modifier is missing." Please help. Thanks.
SuperCoder Answered Wed 01st of March, 2017 02:21:27 AM

Hi,

Blue cross has different policies towards TC, 26 modifiers depending upon the state you belong to. Below is the link for reimbursement policy for one of the states of Amarica. You can get an idea and check with your payer policy accordingly for your state. Hope it helps

https://www.horizonblue.com/sites/default/files/pdf/Modifier 26 Article.pdf

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