Become perfect in coding 26 and TC modifier
In diagnostic radiology, we mostly use 26 modifier and Technical Component (TC). However, still many of us have a lot of difficulty in understanding the use of these modifiers. I myself initially was struggling to use these modifiers. Modifiers are always little tricky to apply with CPT codes. Modifiers play an important role in modifying the procedure and changing the dollar value of the procedure code. We have already learnt previously about how to use 58 and 78 modifier, now we will learn more about 26 and TC modifier.
Read also: Learn how to use 25 and 27 modifier
Difference between 26 modifier and TC modifier
If you have coded diagnostic procedures, you will be very familiar with 26 modifier. This modifier is used very frequently in diagnostic radiology CPT codes. For physician side or professional services, one who reads and interprets the report usually has to assign 26 modifier. Technical Component (TC) is assigned when the physician does not own the equipment or facilities or employs the technician.
In short, 26 modifier is assigned to pay for the physician services only.
While TC modifier is assigned for the facilities used or the equipment used to perform the procedure.
Read also: Secret tips for coding 76 modifier
Points to check for 26 and TC modifier
For 26 modifier, the physician supervises and interprets the results. For example, a boy fall and get some injuries in hand and then he goes to the physician office, the physician thinks he has fracture and wants and X-ray. The physician does not have equipment for X-ray. Therefore, the boy is sent to urgent care department to take an X-ray. Now, the boy returns to the same physician. The physician interprets the result from the films obtained through X-ray machine. Now, here you can understand very well, how the procedure worked. So, now we have to bill the procedure for both the physician and the urgent care department.
73130-26 (X-ray of hand, three views)
73130-TC (X-ray of hand, three views)
Do and Don’t for 26 and TC modifier
Use TC modifier only for the medical equipment, Facility or the technician. Using only TC modifier indicates only the technical portion of the procedure is used.
Use 26 modifier for the physician or professional services only. Also, do use them for CPT codes like 93101 with description interpretation and report only.
When both the professional and technical portion is provided by the physician, we are not supposed to use 26 or TC modifier along with CPT code. In such case, the CPT code will be a global code like 73130 only.