Ob-Gyn Coding Alert

Question: I need clarification in reference to the article in the February 99 issue regarding modifier -26, physicians interpretation of radiology. We have our own ultrasound machine in our office and pay a technician to do the scans. The doctor dictates a separate report after looking at the ultrasound. Recently I have been told that we cannot bill for the reading fee because we are billing for the ultrasound component and the interpretation is included. According to your article, it seems we may legally bill separately for this interpretation. I am confused.

Peggy Johnson, Insurance Biller
Schaumburg Ob-Gyne Associates, S.C., Schaumburg, IL

Answer: An unmodified CPT ultrasound code includes both the technical and professional component of the service. When you do the ultrasound in your office, you bill the ultrasound code without a modifier. If, on the other hand, your physician performs the ultrasound in the hospital, so that a radiology department is billing for the use of the machine (technical component that also includes a technician), your physician can only bill for the professional interpretation (which requires the official written report) by adding a modifier -26 to the ultrasound code. Note that only one physician is going to get paid for the interpretation. If a radiologist does the report, your physician in reviewing that report codes only for the E/M service because the review is part of medical decision-making.