Modifier 26 and the CPC exam

[Darlene]

I have been practicing the Carol Buck final exam from her review guide. Below is an example of one of the questions on the exam.

CLINICAL HISTORY: Boil, left groin.
SPECIMEN RECEIVED: Necrotic fascia left groin and leg (anterior and posterior).
GROSS DESCRIPTION: The specimen is labeled with the the patient's name and "fascia left groin and leg" and consists of multiple segments of skin and soft tissue being hemorrhagic and friable and foul smelling.
MICROSCOPIC DESCRIPTION: Sections of skin and soft tissue show coagulative necrosis with neutrophillic exudates.
DIAGNOSIS: Skin and soft tissue, left groin and leg, anterior and posterior showing coagulative necrosis and acute inflammation.

A) 88304, 680.9
B) 88305-26, 709.8
c) 88304-26, 709.8, 680.2
D)88305, 682.2

I picked C and was correct, but my question is: if it doesn't tell you to code the professional part, how am I supposed to know to do to that? There are a lot of radiology questions like this too. They all want the professional code but I am not sure if that is what they are asking in the examples. As you can tell, I am getting nervous about my upcoming CPC exam and just want to make sure that I am understanding what they are looking for when they aren't actually stating to code the professional side.

 

[Laureen]

Modifier 26 is for procedures that have both a technical and professional component and you want to tell the story another entity is billing for the technical and you are billing for the professional.

The documentation doesn't really give us enough info to make that call but going with the "best of the possible answers" technique answer C is best because of the two diagnoses.

 

[williamcarter]

very informative thanks