Orthopedic Coding Alert

Question: What are the rules and guidelines for billing for radiographic interpretation (x-rays)? We have no radiologist. Instead, our clinic has a contract with the radiologist at our local hospital, who eventually reads all our films and sends a report back to our clinic, usually about a week after the radiograph was taken. In the interim, we take a history, perform a physical examination and do our own radiographic interpretation to make management decisions. When are the interpretation codes allowed and what are the exceptions when they can be charged above and beyond normal E/M codes?

Delaware Subscriber

Answer: If all of the physicians in your group do their own interpretation of x-rays, its time to renegotiate your contract with the local hospital and have it provide the technical component only of the x-ray procedure. If you are interpreting the films anyway due to time constraints, then why pay the hospital radiologist for work that your group is already doing?

If this is the case, you can bill for the x-ray code with modifier -26 (professional component) appended. However, without a renegotiated contract, you cannot bill for even a portion of the x-ray code, as long as the hospital is billing for both the technical and professional components. This is double-dipping and can subject you and your entire group to a costly audit. If the contract is renegotiated and your practice starts to bill for its own interpretive services, the x-ray code with the -26 modifier can be billed in addition to an E/M code for the office visit. Be aware, though, the CPT radiology guidelines specify that a written report signed by the interpreting physician should be considered an integral part of the radiologic procedure or interpretation.