26 TC modifier

We got a denial from Medicare for excessive units on a colonoscopy. We billed the 45380 once with the facility revenue code and once with the physician revenue code because the doctor is an employee of us. We have always billed this way in the past with no problems at all. Medicare now states that we need to bill with the TC and 26 modifiers on the two seperate codes. They could always tell the charges were seperate by the revenue codes before and I thought the TC and 26 were for codes that someone other than who performs the test, reads or interprests the test. Is there some other way I am supposed to be billing this and why has it changed all of a sudden?

re: 26 TC modifier

Those mods do not go with surgery codes. The doctor bill should be going out on a hcfa prof form and the fac bill on a UB with appropriate separate payee/provider (npi numbers). I work in MA and been in the industry a very long time. Not aware of prof./Fac surgery charges ever being billed together on one bill.

re: 26 TC modifier

We are a critical access hospital and we do method 2 billing so as long as the doctor is hospital based everything goes on one bill. It is our RAC telling us to use the modifiers so I don't know if they are confused as to what the modifiers are for or what is going on. It all just happened all of a sudden after years of billing this way with no modifiers.

re: 26 TC modifier

Look at your reimbursement. Is there a problem there because of how you currently bill? Talk to your local medicare fiduciary. See what's on cms.gov