Radiologic S&I question

[Danielle]

I have been taught that every time you see supervision and interpretation you tack a modifier 26 at the end of the code for professional component, is this not the case? I just watched your you tube video about it, and I am a little confused???

I am now a coding instructor teaching what was taught to me but I would like to teach it right

I was asked the other day by a student if Interpretation and Report was the same as Supervision and Interpretation, I told the student no it was not the same but was unsure about the modifier if you would use the 26 modifier on interpretation and report as well?

Thanks for all your help

 

[Laureen]

Thanks for asking Danielle!

First for those wondering where the video is Danielle is referring to here is the link

Ok so lets start with some definitions so we can understand when to append 26 or not.

Global Code = covers both technical and professional components when billed alone
TC = when appened to a global code tells the story it represents the technical piece only
26 = when appended to a global code tells the story it represents the professional piece only
Technical = overhead, use of equipment and staff/techs
Professional = interpretation and report - can be done off site

So you need to go through the thought process when billing for a global code - should I be billing for just the technical piece or just the professional piece or the whole thing - and then assign a modifier accordingly. You go through this consideration for every global code.

If you work for a free standing radiology clinic and they employee and therefore bill for the radiologists then they would bill global codes with no modifier because the provided both the technical and professional components.

If a radiologist works independently and is reviewing xrays etc. from the local hospital and providing an interpretation and report they would bill using a modifier 26 because they only provided the professional piece.

Even if a radiologist works for the hospital the hospital still needs to use a 1500 form for professional services and would therefore also append 26 to the global code. They get paid for the technical component through billing on the UB billing form.

Now for S&I (supervision and interpretation) it is a separate issue. The story here is you need two codes to report the whole procedure - usually one from the surgery section of CPT and one from Radiology. The one from radiology will have the phrase "supervision and interpretation". Here is a clip from the CPT Radiology guidelines "When a procedure is performed by two physicians, the radiologic portion of the procedure is designated as radiological supervision and interpretation. When a physician performs both the procedure and provides the imagining supervision and interpretation, a combination of procedure codes outside the 70000 series and imaging supervision and interpretation codes are used."

The reason there are two codes to tell the story is sometimes you have one physician providing one piece and a radiologist providing the other piece. If the radiologist does both pieces they can bill both codes. Long ago there used to be just one code for these types of interventional procedures but it was too hard to split the fee if two physicians did the work.

And with S&I codes the radiologist needs to do just what it says "supervise AND interpret" - not just interpet.

So the bottom line is - they are two different concepts that often get confused because in my opinion they share the word "interpret".

HTH

 

[Danielle]

Thanks Laureen,

This whole thing can get confusing

So I want to make sure I am reading this right
If the chart says supervision and interpretation we will have to code from surgery and from radiology for example

Code 36500(cardiovascular) says Venous catheterization for selective organ blood sampling
under the code description in parentheses says(for radiological supervision and interpretation use 75893)

Code 75893(Radiology) says Venous sampling through catheter, with or without angiography (eg, for parathyroid hormone, renin), radiological supervision and interpretation

We would have to code both 36500,75893
If we were only coding for the radiological portion of this would we just code 75893-26
If we were only coding the procedure would we just code 36500-TC or leave the modifier off if we did both components

The professional component would be for interpretation and report codes?

It did help a lot! I am going to have to make a handout for my students to explain this, I agree because they share that word "interpret" it gets very confusing
Thanks again!

 

[Laureen]

You almost have it

If we were only coding for the radiological portion of this would we just code 75893-26
If we were only coding the procedure would we just code 36500-TC or leave the modifier off if we did both components

I would re-write that to say:
If we were only coding for the PROFESSIONAL portion of THE S&I CODE we would we code 75893-26
If we were only coding the procedure would we just code 36500 (TC/26 modifiers don't apply to this non-rad code)

 

[Danielle]

okay that is clear to me now thank you so much

 

[Laureen]

If you develop a handout that makes it more clear to students I'd love to see it!

 

[Danielle]

Sure I will try to develop one and get it to you

 

[Danielle]

I am still working on the handout but I have one drawn up how can I get it to you?

 

[Laureen]

Thanks Danielle If it's ready for sharing you can upload here (see "Upload a File" button when you reply). If you want me to look at it first just email it to me. (see link in my signature).