Many of the radiology procedures and services like medical billing for radiology usually entail two equal parts of the process; one professional and one technical component.
The professional aid comes from the professionals; physicians. This includes supervision, interpretation, and a report of the patient. To use up the professional portion of the service, you shall append 26 professional components to the appropriate CPT code. The modifier 26 is more suitable for this action because physicians supervise and track a diagnostic test, even when they have not personally performed it.
On the other hand, the functional part of the service entails the equipment, supplies, and costs of the exam performance. To use up the technical elements of the service, you should deploy the TC mechanical component within the CPT code. The charges for technical component use are reimbursed to the faculty that provides you their equipment. Usually, Hospitals do not have to attach the modifier TC since it is already covered up in the total of each on-site service that you use. However, you should personally confirm this from your service provider before proceeding.
Confirmation of codes
To make sure you are using the right systems, you should consider consulting the National Physician Fee Schedule Relative Value File, which you can access online from multiple sources. If this file shows the line items listed separately in a code of 26 and TC, then the service or procedure in the system entails both the technical and professional service.
Global service (PC and TC)
A “global” service entails PC and TC regarding one service. When the report of global service is covered, modifiers are not a necessity. This is because the payment for the use of the professional and technical component is not entirely necessary.
Complexities and discrepancies
If the person who gives you the professional advice is also the operator and owner of the equipment, it comes under global service, and professional and technical components are billed together. This means that the global service procedure comes on a full fee. You should remember that radiologists who provide their service to patients in a Medicare facility such as a hospital are not eligible to receive the technical portion of the service. As per the Diagnosis-Related Group (DGR), the technical procedure payment goes to the hospital. Likewise, specific Medicare regulations state that refunds for non-physical procedures received at the hospital premises should be given to the hospital only. Even though most of the codes entail technical and professional component service procedures, if the fee schedule does not define the separate values by listing them in a different system with modifier 26 and TC, the modifier and code do not work together for the system, no matter what type of circumstances there are.
There you have it. Now that you have the right information, you can easily make an informed decision.