Medical Coding - Modifier QA

Dr. Raddy, staff radiologist, interprets a chest x-ray that was obtained in the hospital Radiology Department. Dr. Raddy is contracted with the hospital to read radiographs. The equipment and staff are owned and/or employed by the hospital. What modifier, if any, should Dr. Raddy report with the chest x-ray code?

a. No modifier is necessary, since Dr. Raddy interpreted the x-ray under contract with the hospital. The hospital will bill the global and pay Dr. Raddy from the reimbursement.
Incorrect answer. Dr. Raddy should report the chest x-ray code with modifier 26, professional component. If he had performed the service with equipment he owned and staff that he employed, he could

have reported the global, but since the hospital assumed the technical overhead, he can only report the professional component.

b. Modifier 26, professional component.
Correct answer.

c. Modifier TC, technical component.
Incorrect answer.
Dr. Raddy performed the professional component of the split service, not the technical component. He should report modifier 26.

d. Modifier 59.
Incorrect answer.
Modifier 26 is the appropriate modifier to report the professional component of a split service. Modifier 59 is reported only when a specific modifier does not exist.

Tiny PattiSue Smith, 15 days old, currently weighs 1652 grams. She is taken to the operating room for small bowel resection for necrotizing enterocolitis, a frequent complication of prematurity. The remaining portions of the small bowel were anastomosed end-to-end. CPT code 44120 reports a small bowel resection with anastomosis. Is a modifier necessary, and if so, which modifier?

a. No modifier is needed for the surgery, although the anesthesiologist might need a modifier.
Incorrect answer. Modifier 63, procedure performed on infants less than 4 kg should be reported.

b. Modifier 63 is reported because the baby weighs less than 4 kg and thus is a higher surgical risk than a larger neonate.
Correct answer.

c. No modifier is needed, because code 44120 already applies to neonates who are very low weight. Incorrect answer. Code 44120 is not exempt from the assignment of modifier 63, and this modifier should be assigned.

d. A modifier is optional, and may or may not be assigned depending upon the departmental coding guidelines.
Incorrect answer. Modifier 63, procedure performed on infants less than 4 kg should be reported in this case.

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