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Once Read, Imaging Studies Can’t Be Re-Billed

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  • December 12, 2016
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Once Read, Imaging Studies Can’t Be Re-Billed

Question: Can a physicians code separately for reading X-rays or imaging studies taken elsewhere? For instance, could we report the appropriate X-ray CPT® code with modifier 26 Professional component attached?
Answer: If another provider (e.g., hospital radiologist) previously read/interpreted the image, and has issued a report, your physician cannot separately code or be paid for the same work, a second time. For example, if the patient brings an X-ray report with him to his appointment, the provider does not earn payment simply for examining the films to determine the nature of the problem. If the X-ray is relevant to the patient’s complaint, and the provider documents the relevance of this “data to be reviewed,” the effort of reviewing the images counts toward the complexity of medical decision-making (MDM), when determining the appropriate E/M service level.

Evaluation and Management – CEMC

John Verhovshek
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About Has 577 Posts

John Verhovshek, MA, CPC, is a contributing editor at AAPC. He has been covering medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University.

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