Neurosurgery Coding Alert

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

Vermont Subscriber

Answer: Theoretically, any physician may code and charge for any service in the CPT code book. However, only one physician will be paid for reading an x-ray. Thus, if a neurosurgeon reads it and the radiologist in the facility has already done this and generated a report, the neurosurgeon wont get paid. If an x-ray is performed and radiologists are available, they will most likely read the x-ray and bill for it. But if the neurosurgeon reads it instead, he or she must write a separate radiological report that should not be contained in the visit report; after that, the surgeon may bill the appropriate radiological code with modifier -26 (professional component).

If a patient comes to the neurosurgeons office with an x-ray or MRI report, the neurosurgeon cannot charge 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.

A notation that the neurosurgeon reviewed the image can enhance the level of Medical Decision Making, and thus the level of E/M.

Note: Medicare policy states that the interpretation that ultimately guides the further treatment of the patient is the one that should be paid, although in practice the first claim received is the one that is paid. Coordinating these charges can be a delicate situation between neuro-surgeons and radiologists, often with the facility in the uncomfortable role of referee.