Forum - Questions & Answers
Biopsies and Modifiers
I bill in a Facility Setting. All equipment is owned by us and a Radiolist performs Biopsies using our equipment in our Facilty.
I'm a bit confused as to what codes I'm suppose to use (TC) and what codes the Radiolist is suppose to bill (26)
For Thyroid : 60100
For Breast: 19102
Ultrasound guidance: 76942
FNA: 10022
I know for each lesion biopsied we can use 10022-59, Ultrasonic Guidance can only be billed once. But What I'm trying to comprehend is what codes Are suppose to be billed by us the Facility (TC) and by the Radiology Group (26).
Any help is greaty appreciated!! :)
-Becky
re: Biopsies and Modifiers
Surgical procedures (biopsy for example) do not have a technical and professional component. Diagnostic tests have a TC and PC. You can look at the code on the Medicare website to see if the service has a TC and a PC.
If you provide both, bill the code with no modifier. If you provide the TC (staff, machine, "film" supplies) bill the TC. The physician who interprets the test reports the PC.
http://codapedia.com/article_265_Modifier-26.cfm
http://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx