Medical Auditing Practice Exam

Which scenario best illustrates the correct use of modifier 26?

1. A chest X-ray taken in a private clinic with a full facility charge

2. A chest X-ray interpreted by a hospital-based physician with full global billing

3. A chest X-ray taken in the ED with billing for interpretation by an independent physician

4. A chest X-ray performed by a technician without a professional interpretation

The correct answer is: A chest X-ray taken in the ED with billing for interpretation by an independent physician

The correct choice highlights a scenario that effectively illustrates modifier 26's appropriate application in medical billing. Modifier 26 is used to indicate that a physician's professional component of a service, such as the interpretation of an X-ray, is being billed separately from the technical component, which encompasses the actual performance of the procedure. In this scenario, the chest X-ray taken in the emergency department (ED) is distinct in that the interpretation is billed by an independent physician rather than the facility where the service was performed. Here, the technical aspect of the chest X-ray is performed in the ED, but since the interpretation is being handled by an independent physician who is not affiliated with that particular facility, it showcases the involvement of the professional component distinctly from the technical component provided by the ED. Other scenarios do not exemplify the use of modifier 26 effectively. For instance, a chest X-ray done in a private clinic with a full facility charge usually does not separate the physician’s interpretation from the technical fee. Similarly, a hospital-based physician interpreting an X-ray with full global billing implies that the facility and professional components are bundled together, not separately billed. Lastly, a chest X-ray performed by a technician without a professional interpretation cannot apply modifier 26, as there