Question

A radiologist is asked to review a patient's CT scan that was taken at another facility. The modifier -26 attached to the code indicates that the physician is billing for what component of the procedure?

A) confirmatory
B) professional
C) global
D) technical

Answer 1

The -26 modifier is used when billing for the professional component of a medical service separate from the technical component. It is applicable when a radiologist provides analysis and interpretation of a CT scan performed at another facility.

Step-by-step explanation:

The modifier -26 attached to a code in a medical billing context indicates that the physician is billing for the professional component of the procedure. This separates the physician's service from the technical or facility of service that may have been provided by another party, such as the facility where the CT scan was originally taken.

A radiologist reviewing a CT scan taken at another facility and utilizing the -26 modifier is thus indicating that they are providing the professional analysis and interpretation of the imaging results, but not billing for the technical aspect which includes taking the scan and using the equipment. This distinction is important in medical billing to ensure that each entity is appropriately compensated for their part in a patient's care. It is common in cases where technical services are provided by the hospital or imaging center, and the professional services are provided by the physician or radiologist.