Cracking the Code

Coding Modifier TC vs 26

Modifiers TC and 26 often stump coders and auditors. When should it be used? What are the requirements? How do I know which one is most appropriate? Questions like these are very common for these modifiers. Understanding their uses will help ease the confusion.

What is modifier 26? Modifier 26 is defined as the Professional Component. Certain procedures are a combination of a physician or other qualified healthcare professional component and a technical component. When the physician or other qualified healthcare professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. The correct usage of this modifier is when we are to bill only the professional component portion of a test when the provider utilizes equipment owned by a hospital (facility). It also reports the physician’s interpretation of a test which is separate, distinct, written and signed.

What is modifier TC? Modifier TC is defined as the Technical Component. The technical component includes the services of all equipment, supplies, personnel, and costs relates to the performance of the procedure. Fees for the technical component are normally reimbursed to the facility or practice that provides or pays for the supplies, equipment, and/or clinical staff such as the technicians.

Q: Catheter is advanced from the right femoral vein into the left and right pulmonary artery. The catheter was further negotiated into the right lung lower lobe. Pulmonary angiography performed in all locations including radiologic supervision and interpretation. What are the CPT code(s) reported?
A: 36015-RT, 36014-59-LT, 75743-26, 75774-26 Rationale: Looking in our CPT Index for Pulmonary Artery/Catheterization referring us to 36013-36015. 36015-RT reports the second order selective catheterization of the right pulmonary artery; 36014-59-LT reports the first order selective catheterization in a different family of the left pulmonary artery. Next, let’s look in our CPT Index for Angiography/Pulmonary referring you to 75741-75746, 93568. Code 75743 reports bilateral pulmonary angiography, and 75774 reports the additional angiography after the basic study of the right and left pulmonary arteries. We append modifier 26 to both the 75743 and 75774 for the professional component as documented. Finally, we look in our CPT Index for Angiography/Other Artery referring us to 75774.
Reference: FY 2023 CPT codebook, Novitas Solutions
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