tci ED Coding & Reimbursement Alert - 2022 Issue Q3

Modifier Madness: Partial Service Coding Depends on 26, 54

Do you know when to use professional component modifier? There are times when your physician will provide only a portion of a service represented by a particular CPT® code. When this occurs, you might need help from a couple of modifiers in order to untangle your ED provider’s deserved reimbursement from the other relative value units (RVUs) of the CPT® code. Enter 26, 54: Modifiers 26 (Professional component) and 54 (Surgical care only) are frequently used in these situations to show the payer that you are only coding for the portion of the service your surgeon performs. Check...

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