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Q: After a patient has an x-ray, the radiologist reads it and determines that the patient requires surgery. Can both the radiologist and the surgeon bill for the reading professional component of the x-ray?

Patient Financial Services Weekly Advisor, September 9, 2005

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 or 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 Stacie Buck, RHIA, LHRM, vice president of Southeast Radiology Management in Stuart, FL.

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