General Surgery Coding Alert

Tip: Only 1 physician can bill for dx test analysis

Just because your surgeon orders and interprets an angiogram, X-ray, magnetic resonance imaging (MRI) or other diagnostic test doesn't mean you can bill separately for the service.
 
Even when the surgeon cannot bill separately for the interpretation, however, you can consider the test as a factor in medical decision-making when choosing an E/M level.

Avoid Double-Billing

Before billing for any diagnostic test interpretations in an inpatient setting, be sure that another physician hasn't already laid claim to the service.
 
A possible scenario: During placement of an endovascular prosthetic for repair of abdominal aortic aneurysm, the surgeon orders an angiogram (75952, Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and interpretation) for visualization.
 
Why you probably can't bill the interp: In the hospital or other inpatient setting, a facility radiologist or other physician may provide interpretations for all ordered tests as a matter of policy. And if one physician interprets a test and provides a report outlining the result, no other physician can bill for the same service, because this would constitute "double-billing," says says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of Cash Flow Solutions Inc., in Brick, N.J., and a member of the AAPC National Advisory Board.
 
You probably could not report the angiogram interpretation for the surgeon in the above scenario because, very likely, the hospital radiologist would prepare the initial report for the angiogram. Even when the surgeon provides the immediate interpretation used for treatment and the radiologist provides an "over-read," hospital rules may give the charge to the radiologist.
 
What if your physician disagrees? There are those coders and physicians who feel that if the ordering physician disagrees with the radiologist's interpretation, and if the physician writes his own full report of the test, the ordering physician's report counts as a correctly formatted radiological report with a conflicting outcome.
 
If this is the case, you may attempt to bill for the ordering physician's interpretation, Cobuzzi says. But the payer will likely deny the charge, and you will be forced to appeal with the documentation

Consider Test Results Toward E/M Level

Although the surgeon may not be able to claim separate reimbursement for test interpretation if another physician has already provided a report, the surgeon can consider her own reading of the test results as a component of medical decision-making, which may affect the level of any E/M service she provides, Cobuzzi says.
 
This is because the amount and/or complexity of medical records, diagnostic tests and other information that the physician must consider when examining the patient is itself a key component of medical decision-making, according to CPT guidelines - and reading test results falls into this category.
 
If the physician documents that the actual image was reviewed, auditors can typically increase the "Amount and/or Complexity of Data." 
 
Example: In the emergency department, the surgeon attends to a patient involved in a recent automobile accident. The patient complains of pain and tenderness in his ribs and chest. To check for rib fractures or other injuries, the surgeon orders an x-ray (for example, 71020, Radiologic examination, chest, two views, frontal and lateral). The hospital radiologist provides the report, which becomes part of the medical record the surgeon must consider when making treatment decisions for the patient.
 
Based on the key components of history, exam and medical decision-making (which includes consideration of the test results), the surgeon documents a level-three  observation admission (99220, Initial observation care, per day, for the evaluation and management of a patient ...).

When You CAN Bill, Append -26

When the surgeon legitimately provides the only interpretation and report for a diagnostic study, you must still remember to append modifier -26 (Professional component) to the appropriate CPT code to describe the test, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, director and senior instructor for CRN Institute, an online coding certification training center based in Absecon, N.J. Appendix A ("Modifiers") of CPT explains that some procedures are a combination of a technical component and a physician (or professional) component.
 
If the physician provides both components of the service, he may report the appropriate CPT code with no modifiers. But "When the physician component is reported separately," CPT specifies, "the service may be identified by adding modifier '-26' to the usual procedure number." In the latter case, the facility providing the equipment may claim the "technical component" of the service (the cost of equipment, supplies, technician salaries, etc.) by reporting the appropriate CPT code with modifier -TC (Technical component) appended.
 
Therefore, if the surgeon provides the initial interpretation and report for the angiogram in the first example above, you are justified in reporting 75952 in addition to the endovascular AAA repair.
 
You should append modifier -26 to 75952, nevertheless, to show that the surgeon did not provide the equipment that the test was conducted on.