Who can bill for an x-ray when a patient requires surgery?
Compliance Monitor, September 2, 2005
Want to receive articles like this one in your inbox? Subscribe to Compliance Monitor!
Q. A patient has an x-ray done and the radiologist reads the x-ray. It is determined the patient requires surgery. Can both the radiologist and the surgeon bill for the reading "professional component" of the x-ray?
A. The surgeon should not bill for the interpretation of the x-ray. The surgeon is merely using the results in his medical decision making which is factored into his evaluation and management (E/M) service.
According to CPT Assistant, October 1997, "The levels of E/M codes include the review of results of tests already interpreted by another physician." CPT Assistant goes on to mention that if a physician provides the initial interpretation of the films and provides a separate, signed, written report then he/she should report the procedure with the -26 modifier. Reviews or re-reads for previously interpreted exams should not be billed by other physicians.
This answer was provided by
Want to receive articles like this one in your inbox? Subscribe to Compliance Monitor!
Related Products
-
Strategies for Health Care Compliance
News and real-life examples to increase the effectiveness of your compliance program. Strategies for Health Care Compliance...
-
Compliance Monitor
This HTML e-mail newsletter delivers news on Medicare and Medicaid fraud and abuse, as well as recent documents and targets...
-
Medicare Weekly Update
Each issue of Medicare Weekly Update includes the latest CMS proposed and final rules, CMS manual revisions, and...
-
Medicare Update for Physician Services
Medicare Update for Physician Services is a free, monthly e-zine that delivers news and information to help physician...
Most Popular
- Articles
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HIPAA Q&A: Level of encryption needed for email
- Catch up on what's new with injections and infusions
- Identify potential Medicaid RAC target areas
- Topic: CMS, OESS post new security compliance review information, checklist
- Capturing all necessary codes for IUD insertion and removal can be challenging
- What does case-mix index mean to you?
- OB services: Coding inside and outside of the package
- QA:Coding multiple initial infusions
- E-mailed
-
- Q/A: Volume requirement for reporting hydration services
- Featured blog post: Nurses face felony charges after reporting physician to the Texas Medical Board
- HIPAA Q&A: Level of encryption needed for email
- CMS has reformulated payments for some bilateral procedures
- Q&A: Follow CMS' coding guidelines when using modifier -25
- What does case-mix index mean to you?
- Catch up on what's new with injections and infusions
- New conflicts of interest create new challenges
- Q/A. One injection code or two?
- Cohesive History and Physical Requirements
- Searched