Pulmonology Coding Alert

Question: Our pulmonologist was recently called upon to analyze chest x-ray images (frontal) for a patient. How should I bill for x-ray interpretation when the office does not own or lease the equipment?

Idaho Subscriber

Answer:  As you do not own the equipment, you should report the professional component of the service. All the radiological services – and hence the corresponding codes (70010-79999) – in the CPT® manual include both the professional and technical components of the procedure. The professional component includes the physician’s work of interpreting the results and issuing a report whereas the technical component of the service covers labor, equipment, and supplies. In your case, if the physician who is reading the report also owns the equipment, he would straightaway bill for code such as 71010 (Radiologic examination, chest; single view, frontal).

However, in case of one or the other condition not being met, you will have to use modifiers that are used with these x-ray codes to specify the components which the billing physician handled. You will use modifier 26 (Professional component) appended to the radiologic code when the physician performs only the professional component, such as interpretation. Modifier TC (Technical component) is appended to the x-ray code to show that the physician owns the equipment and wants to recover the reimbursement for the technical component. Since your physician does not own the equipment, you can only report the professional component (71010-26), because this involves the interpretation of the films and the report of findings.

A pulmonologist should not bill for interpretation (71010-26) if that has also been performed by a radiologist. If the radiologist performs the x-ray and also interprets the x-ray before sending the results to you, the radiologist will bill for the professional component.

You cannot bill for an overread unless it is medically necessary to do so because you feel that there was an error in the initial interpretation.  Instead, incorporate the review into the data review section of medical decision making when selecting the visit level. Remember to include the relevant diagnosis code 480.2 (Pneumonia due to parainfluenza virus). Under ICD-10, you would diagnose the same condition as J12.2 (Parainfluenza virus pneumonia).