RadVCCoder
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Hi!
I am wondering if we should be billing with a 52 mod on 74328 and 74740? We are the radiologist doing the interpretation.
This is the guidance I have been provided and i just want to make sure is correct.
Most likely, the radiologist did not supervise the procedure (e.g., did not control the imaging, direct the techs, or oversee contrast injection in real time) and only provided the interpretation. Some payers allow the 26 modifier for the professional component if only the interpretation was done. Since CPT 74328 and 74740 are global codes that include both supervision and interpretation, just coding the 26 for the interpretation is not the full professional component and adding a 52 modifier is more accurate to let the payer know that only part of the service was performed by the radiologist.
Here is an example report:
XR HYSTEROSALPINGOGRAM ROUTINE
INDICATION:
fertility testing,Other,Fertility testing
FLUOROSCOPY TIME:
0.5 min.
RADIATION DOSE:
2.5 mGy - Air Kerma Technique
FINDINGS:
The endometrial canal is opacified with contrast. There are no filling
defects. The right and left fallopian tubes are patent with free
intraperitoneal spillage bilaterally.
IMPRESSION:
1. The bilateral fallopian tubes are patent with free intraperitoneal spillage
bilaterally.
I am wondering if we should be billing with a 52 mod on 74328 and 74740? We are the radiologist doing the interpretation.
This is the guidance I have been provided and i just want to make sure is correct.
Most likely, the radiologist did not supervise the procedure (e.g., did not control the imaging, direct the techs, or oversee contrast injection in real time) and only provided the interpretation. Some payers allow the 26 modifier for the professional component if only the interpretation was done. Since CPT 74328 and 74740 are global codes that include both supervision and interpretation, just coding the 26 for the interpretation is not the full professional component and adding a 52 modifier is more accurate to let the payer know that only part of the service was performed by the radiologist.
Here is an example report:
XR HYSTEROSALPINGOGRAM ROUTINE
INDICATION:
fertility testing,Other,Fertility testing
FLUOROSCOPY TIME:
0.5 min.
RADIATION DOSE:
2.5 mGy - Air Kerma Technique
FINDINGS:
The endometrial canal is opacified with contrast. There are no filling
defects. The right and left fallopian tubes are patent with free
intraperitoneal spillage bilaterally.
IMPRESSION:
1. The bilateral fallopian tubes are patent with free intraperitoneal spillage
bilaterally.