Radiology Coding Alert

Question: Is there any time when I can't code for a mammogram over-read? Our radiology practice seems to document these a lot.


Vermont Subscriber


Answer: There are quite a few concerns when it comes to over-reads. Most important for you: Don't code an over-read done in conjunction with another exam, such as an over-read done for comparison views or one done to tailor a follow-up exam.
 
Example: A patient comes in for an ultrasound related to a breast mass. She had a mammogram at another facility, and your physician looks at that mammogram to prepare for the ultrasound.

You can't code that reading because the physician is merely reviewing the medical record.

Watch for: Some practices negotiate a rate with a referring practice for over-reads, meaning the referring practice pays a flat rate to the radiologist providing the over-read. If your practice provides these over-reads, you generally should not code for that service. Instead, your practice will bill the referring practice for the specific over-reads performed.

Caution: Your radiologist may face a liability issue if he reads a mammogram taken elsewhere, because he doesn't know the condition of the equipment or the competence of the technicians.