Ultrasound Coded With Modifier 26

Reimbursement codes normally include payment for the use of the facilities as well as for the physicians professional services

. If a physician provides services with the help of someone elses facilities, you need to add modifier 26 to the billing code. For instance, if a physician tends to a patient in an emergency room, the hospital will bill for the facility fee, while the doctor will bill his service with a modifier 26.

Some procedures are a mixture of a physician component (Modifier 26) and a technical component (Modifier TC). When the physician component or technical component is done by separate physicians, you need to add Modifier 26 or Modifier TC to the submitted CPT code and HCPCS code. A code is reimbursable with a Modifier 26 or Modifier TC components. Codes submitted with Modifier 26 or Modifier TC when therere no separate RVUs assigned will be part of the global reimbursement.

"Is ultrasound coded with modifier 26?"

The answer is yes; ultrasound can be coded with modifier 26, TC (technical component) or without modifier. It depends upon the situation and place where this was carried out, but 26 is used mostly.

Heres a scenario: A doctor carries out a breast biopsy with ultrasound guidance at a surgery center. The radiologist carries out the ultrasound during the procedure and the doctor dictates in the operative report that the ultrasound was done and where it showed the mass was. Can the physician bill for the ultrasound with a 26 and if so does a separate radiology report have to be dictated to bill with a 26?

For answers to questions such as these, sign up for a one-stop medical coding guide. Such a site will provide you with modifier guidelines and all possible information that you need to know about modifiers.

by: James Article

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