MEDICAL BILLING AND CODING

Sunday, June 20, 2010

TECHNICAL & PROFESSIONAL COMPONENTS (RADIOLOGY

Only certain services include a technical and professional component. Your Medicare Fee Schedule includes separate allowances for these services.

-TC Technical component. Under certain circumstances, a charge may be made for the
technical components alone. Under those circumstances the technical component charge isidentified by adding modifier TC to the usual procedure number.

Modifier TC identifies those situations where the physician performs the test but does notinterpret the results.

Modifier –TC should not be used if there is a specific code that describes a procedure that is 100%

-26 Professional Component: Certain procedures are a combination of a physician componentand a technical component. When the physician component is reported separately, the service may be identified by adding the modifier -26 to the usual procedure code.
Use modifier 26 when a physician interprets but does not perform the test. Modifier -26 should
not be used if there is a specific code that already describes only the physician component of agiven service.

-GG Performance and payment of a screening mammogram and diagnostic mammogram on
the same patient, same day.

HEALTH PROFESSIONAL SHORTAGE AREA (HPSA)

Federal Law permits special payment for professional services provided by physicians in federally designated geographic Health Professional Shortage Areas (HPSAs). Physicians whoprovide covered Medicare services in rural or urban HPSAs are eligible for a 10-percent incentive payment.

Eligibility for the incentive payment is based on provider specialty and the location where the services were rendered, not necessarily where the physician office
maintains.
AQ MODIFIER:

-AQ Physician providing a service in an unlisted Health Professional Shortage Area
Submit modifier –AQ in the following instances:
When you provide services in zip code areas that do not fall entirely within a designated full county HPSA bonus area.
When you provide services in a zip code area that falls partially within a full county HPSA but is not considered to be in that county based on the USPS dominance decision.
When you provide services in a zip code area that falls partially within a non-full county HPSA.
When you provide services in a zip code area that was not included in the automated file of HPSA areas based on the date of the data run used to create the file.

Do not submit modifier -AQ in the following instances:
Your global code contains a technical component
You are submitting a technical-only component code