May 30, 2013
Our surgeon performs US biopsies in the office and in the ASC. When performed in the office, we report 76942 to the payor. I am told when we perform the same procedure in the ASC, I have to append a modifier 26 to CPT code 76942. I don’t understand why.
CPT code 76942 is considered to be a global radiology code. The payment for this procedure includes payment for the professional component, (modifier 26) and the technical component (TC modifier). You may report the global radiology code in your office because you own the equipment and the surgeon performs the professional interpretation and documents a separate report. When you perform the same service in the ASC, you must append the modifier 26, (76942-26) to indicate the surgeon is only reporting the service associated with the professional interpretation because you do not own the equipment. The facility reports the same code with a TC modifier as appropriate.