Orthopedic Coding Alert

Question: One of our physicians bills for interpretations of previously taken x-rays brought in with the patient at the time of their visit. He states that certain E/M codes allow him to do this and others do not. These x-rays may have come from the primary care physician and thus do not have a radiologists reading, and some are special studies and/or hospital films which do not have a radiologists report. He is billing the x-ray code with a modifier -26 (professional component). Is this correct?

Anonymous GA Subscriber

Answer: Review and/or ordering x-rays is included in all E/M services as part of the decision-making. When a physician decides to perform an interpretation of an x-ray, his documentation must include a separate, signed written report that would be the equivalent of what is provided by a radiologist. It should include the number of views, all findings, any appropriate comparisons to other films, and documentation of any contrast used or special equipment used. If a report is available to the physician with the findings of the original reading, the physician must have some reason to believe that the original reading is incorrect to justify billing for the x-ray interpretation a second time.