Otolaryngology Coding Alert

Question: In the July 2002 Otolaryngology Coding Alert a reader had a question regarding x-ray interpretations. What about using 76140 for this service? Louisiana Subscriber Answer: The reader question "X-Ray Interpretations" on page 54 of the July issue describes a case in which a patient brings the films to the visit. Although the otolaryngologist has received the radiology report, she reads the film again, stating that the reports are often inaccurate. The answer advised not to bill for the professional component of these services using 70450 (Computerized axial tomography, head or brain; without contrast material), 70552 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem]; with contrast material[s]) or 70210 (Radiologic examination, sinuses, paranasal, less than three views) appended with modifier -26 (Professional component). Although many otolaryngologists often look at the x-rays after the radiologist's report, a radiologist still usually examines the film and conducts the written report. Carriers will reimburse for only one x-ray interpretation. If your physician dictates the full written radiology report and the radiologist performs no role, you can report one of these services appended with the professional component. However, you would have to coordinate the billing with the radiologist and the facility, which may prove more troublesome and contentious than the reimbursement is worth. The same reasoning applies to 76140 (Consultation on x-ray examination made elsewhere, written report). Although the term "consultation" may lead you to believe that your otolaryngologist is providing a consultatory service, this is an inaccurate interpretation. You should use 76140 when a physician is concerned over an x-ray interpretation and requests the expertise of another doctor to read the film. CPT Assistant Summer 1991 clarifies the code in the following example: "Doctor A from Sunnydale Hospital sends a radiograph taken at Sunnydale Hospital to Doctor B at Goodhope Hospital. Doctor A asks Doctor B to offer his opinion on the radiograph. Doctor B writes a formal report on his interpretation of the radiograph and sends a copy of this report to Doctor K."

"This code is not intended to be used by physicians within the same institution to reread radiographs taken at that institution," CPT explains. "Levels of service (limited, intermediate, extended, comprehensive) include the 'evaluation of appropriate diagnostic tests' which may necessitate the attending physician to personally review the radiographs taken on his patient."

Your otolaryngologist should not use 76140 to capture the time involved in interpreting x-rays. She may include the medical decision-making in the E/M office visit, as the answer recommended for the other x-ray interpretation codes.