Coding for Imaging Services

In most cases imaging services are split into technical and professional components.  A modifier for the technical component is added to the 5 digit CPT code (copyright per AMA).  The abbreviation for the technical component is TC and the abbreviation for the professional component is PC. 

The PC of an imaging service is for the physician’s work interpreting a diagnostic test or performing a procedure.  The modifier for PC is 26.  Depending upon the provider pricing guidelines the PC or the 26 may be added to the 5 digit CPT code to communicate that the pricing is for the physician’s portion of the imaging. (I.e. 71010-26 or 71010-TC)

The TC of an imaging service is for the non-physician work.  This portion of the imaging includes the administrative, personnel, equipment and equipment cost related to the testing.  Depending upon the provider guidelines the TC or 27 is added to the 5 digit CPT code.

Generally speaking the charge for the technical component is higher than the charge for the professional component.  However, the cost of the professional plus the cost for the technical component is not larger than the charge for the global service.  The global code is the 5 digit CPT code without modifiers.  Without modifiers appended to the CPT code it describes an imaging service in which the same billing entity provided both the professional and technical component of the service.  An example of this would be a chest x-ray that was done in the MD office and the MD in that office read the x-ray. 

Now, if this is not enough to think about, it should be noted that not all imaging services can be distinctly split into a professional and technical component.  Examples of these types of services would be the interventional radiology services (CPT codes 77401-77416).  These codes are billed as global services.

When reviewing the charges for imaging services it is important to determine if the charges are for the TC, the PC or are global. This ensures the appropriate assessment of the billing for the imaging service(s) provided.  This is not always a straight forward process.  Often there are two separate providers with two separate bills that are issued without the modifier to identify the partial service provided.  The appropriate billing price must be assessed relying on the place of service and the type of provider entity.