tci Outpatient Facility Coding Alert - 2019 Issue Q3
Policy Changes: Implement This Major Policy Change for Modifier 26, TC Billing
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Article Overview
This article covers a CMS policy update affecting how date of service is reported for certain radiology and imaging claims, especially when professional and technical components are split between different claims. It is aimed at coders, billing staff, and radiology practices that need to understand the operational impact of the change and review documentation practices accordingly. The discussion includes background from CMS guidance, practical workflow considerations, and provider commentary on scenarios that may be affected.
Why This Topic Matters
Correct date-of-service reporting can affect claim processing for radiology services billed with separate components. The article helps readers recognize when the new policy may change routine billing workflows and where extra review may be needed.
Article Sections
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Break Down the New Policy Piece-By-Piece
Introduces the CMS guidance at a high level and explains that the article focuses on date-of-service reporting changes for certain radiology claims. It also frames the discussion around separate billing for professional and technical components.
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See How Physician Coders Are Affected
Describes the operational impact of the CMS update on physician-side claim handling and documentation review. The section also discusses situations where the timing of interpretation may differ from the imaging date.
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Get Some Important Physician Background
Provides broader clinical and workflow context from a radiology physician perspective. It discusses factors that influence when imaging studies are interpreted and how that timing may vary by setting and urgency.
What You Will Learn
- The general CMS policy change affecting date-of-service reporting for radiology claims
- How separate professional and technical component billing is impacted
- What kinds of radiology workflows may require closer review of documentation timing
- Which claim scenarios may be more likely to create date-of-service mismatches
- How CMS guidance is framed for professional claims and component-based billing
Who Should Read This
- Radiology coders
- Physician coders
- Hospital billing staff
- IDTF coders
- Radiology practice managers
- Compliance and audit staff
Codes Discussed
Modifiers Discussed
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