General Surgery Coding Alert

Question: Can general surgeons charge for reading x-rays and MRIs taken at an outside facility?

Anonymous Vermont Subscriber

Answer: Only one physician will be paid for reading an x-ray. Consequently, if a surgeon reads the x-ray and the radiologist in the facility already has read it and generated a report, the surgeon wont get paid, says Karen Evans, RN, CPC, a coding and reimbursement specialist in Mount Vernon, Wash.

If an x-ray is performed and radiologists are available, they most likely will read the x-ray and bill for it. If the surgeon reads it, however, he or she must write a separate radiological report that should not be contained in the visit report; then, the surgeon may bill the appropriate radiological code with modifier -26 (professional component) attached.

If a patient comes to the surgeons office with an x-ray or MRI report in hand, the surgeon cannot charge simply for examining the films to determine the nature of the problem because he or she is not necessarily interpreting the results. Rather, the results are being used to help in the care and treatment of the patient. This is considered part of the medical decision-making component of the visit.

Note: Medicare policy states that the interpretation that ultimately guides the further treatment of the patient is the one that should be paid; however, this is often a very delicate situation between surgeons and radiologists.