Corporate Compliance

Who can bill for an x-ray when a patient requires surgery?

Compliance Monitor, September 2, 2005

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