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Radiology Section of CPC Exam — Understanding Modifier 26


Laureen: Q: This question was: I was reviewing
Laureen’s Blitz Video yesterday on radiology and I wanted you to clear up something for
me. She stated “supervision and administration…” This is so funny; I didn’t pick up the first
time that she was talking about me. I thought she’s talking about another instructor, and
I’m like, “Yeah, she got it wrong, it’s supervision and interpretation.” So if I said “supervision
and administration” I meant to say “supervision and interpretation.” If you could just click on the answer sheet
— Alicia: I’m moving over now. Laureen: This is something – we answered this
and I went and searched our website and I found a video answer that we had down on a
previous webinar but it was 2012, even though the answer is still the same, I thought it
was worth answering again because this is a topic that really seemed to some people
in the radiology section of CPC exam, how to understand supervision and interpretation,
what does that mean? Just keep scrolling down past the green
and I want them to see the little clip of my CT manual, there you go. Alicia: OK. Laureen: Right there, for those on the Replay
Club I gave you the link to the previous answer that we did on this. Right below it, this
is how I teach it in the course, “supervision and interpretation,” when you see that you
want to think this is part of a two-code story, okay? If you look at these codes and I just
grabbed a little quick shot of my CPT manual, you’ll see right below 20225 in the parenthetical
note, it says: “For radiologic supervision and interpretation, see 77002.” These two codes in the 20,000 series are in
the surgery section of the musculoskeletal system, so they are surgery code. Then, there
are corresponding radiology codes that go with it, it’s part of a two-part story. The
history on this is way back in the day they only had one code to represent one of these
types of procedures. They were finding that — because the intention was one guy was doing
it or one woman, but sometimes they actually bring a surgeon in to do the surgery piece
and then the radiologist would do the radiology piece and they couldn’t figure out mathematically
how to divide the codes because in some cases the surgery piece was a lot more of the pie
than the radiology and vice versa. So they just said, “You know what? Let’s just
have separate code. So, you use the surgery codes for that piece of the story and you
use the radiology codes for that piece of story. ” If the physician that you’re coding
for did both pieces then you code both codes, if they only did one piece you just code the
one piece. So, all that “supervision and interpretation” is a heads-up that it’s part of that two-code
story. Did I – didn’t do the guidelines a little
bit below that? Alicia: That’s the end. Laureen: OK. Yeah, there’s a little more in
purple there. So, for some reason this gets confused with modifier 26 for the professional
component. I hate to even say it here because I don’t want you thinking has anything to
do with it; but because it always gets confused, I just want you to make a note somewhere in
your manual, the radiology guidelines perhaps, where they talk about supervision and interpretation,
that is has absolutely NOTHING to do to with modifier 26. This means, professional component
(Interpretation & Report) is normally how people will phrase it. The only thing in common
is they share that one word “interpretation” but they’re two different concepts in the
radiology section. With modifier 26 you’re just trying to — if
you append that modifier you’re telling the story to the payer that your physician should
only get paid for the professional piece. In other words, they’re not a freestanding
radiology clinic that should also get paid for the x-ray equipment, the rad tech, the
technical piece. Two different pieces, so S&I has to do with being part of a two-code
story and 26 has to do with professional component only on that. OK? Hopefully that will help
with that, and if I said “supervision and administration,” then that was a slip of the
tongue and I meant “interpretation”. Alicia: Good job. And then reiterating, Laureen
has a CEU package for modifiers so it has the modifier in it, amazing tool. When you
have the concept, does it take away money or does it add money or does it stay the same,
that kind of helps you understand that as well. I think. Laureen: All about the money. Alicia: Yup, all about the money.

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