How do you handle radiology codes when both professional and technical components are involved?

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Handling Radiology Codes When Both Professional and Technical Components Are Involved

As students in a medical coding course, one of the trickiest but most important topics is understanding how radiology services are coded when they include both professional (PC) and technical (TC) components. Getting this right leads to accurate reimbursement, fewer claim denials, and higher coding quality.

What are Professional & Technical Components?

• The Professional Component (PC) refers to the physician’s work: interpreting diagnostic images, preparing and signing a report, supervising, etc. ● When PC is billed separately we use modifier 26.

• The Technical Component (TC) covers everything else: the machinery, supplies, personnel (technicians), facility costs, etc. When billed separately, use modifier TC.

• A global service includes both components together—no modifier is needed because it is assumed the provider handles both.

When & How Both Components Apply

1. Codes with PC/TC Indicator = 1 in CMS’s Physician Fee Schedule (PFS) have both professional and technical components eligible for separate billing.

2. If only one component is rendered (for example, a radiology facility provides the imaging but an outside radiologist interprets), then you might bill TC separately by the facility and PC separately by the radiologist.

3. Some settings change who gets paid for what. For example, inpatients in a hospital: often the technical component is bundled into the hospital’s payment (under DRG, etc.), and not separately paid to the facility doing imaging.

Key Stats & Trends

• In 2021, only 1.1% of radiologists’ commercial claims were out‐of‐network, down sharply from 12.6% in 2007. This shows increasing standardization & payer oversight.

• Though I didn’t find a reliable number for “percentage of radiology codes that are PC/TC split codes,” published policies like UnitedHealthcare’s confirm many CPT/HCPCS codes use the PC/TC indicator system and reimbursement is adjusted accordingly.

Why This Matters for Coding Students

• Mistakes in applying modifiers 26 or TC, or incorrectly using global vs split billing, lead to denials or underpayment.

• Understanding RVU (Relative Value Units) splits is critical; for example, code 74020 (“Radiologic examination, abdomen; complete …”) has a total RVU of ~1.04, of which ~0.66 is technical and ~0.38 professional.

• You’ll be dealing with different payer rules: Medicare, commercial insurers, etc. Each may handle PC/TC differently, especially in facility vs non-facility settings.

Quality Thought & How We Help

Here’s where Quality Thought comes in: high quality coding isn't just about “getting it done” but about precision, integrity, and educational rigor. We ensure every coding student not only learns the rules but internalizes them. When you practice real-world scenarios with both PC and TC components, you learn to avoid pitfalls.

With our courses:

• We include hands-on coding labs focusing specifically on PC/TC splits and modifier application.

• We use up-to-date fee schedule data (e.g. CMS NPFS) so students see current PC/TC indicators and RVU splits.

• We provide quizzes and mock audits to simulate what payers check (e.g. inpatient claims where TC may be disallowed).

• We teach “Quality Thought” approaches: double checking code validity, ensuring documentation supports PC vs TC, using the right modifiers, avoiding over- or under-coding.

Conclusion

For medical coding students, mastering professional and technical components in radiology is essential. It means knowing which codes allow split billing, applying modifiers 26 (PC) and TC correctly, understanding payer settings and facility vs non-facility rules, and working with RVU splits. With increasing regulation and payer sophistication, errors in PC/TC coding can have real consequences. By embedding Quality Thought into your coding practice and training with courses that emphasize both rule knowledge and real-case practice, you’ll be far better prepared.

Are you ready to deepen your understanding of PC/TC coding and ensure every radiology code you assign stands up to scrutiny?

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