Confused - E/M and Ordering Xrays

anne32

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I am confused about the professional and technical component of xrays. Where I work, the provider either performs the x-ray and reads it or sends the patient to an outside clinic where they perform the x-ray and also read it. In this case, we would bill both components if we do it or if they are sent to and outside clinic we would bill nothing since they are doing both components? Am I understanding this correctly?

Also if we only do the prof or tech comp can we just count it under the data section of the E/M and not separately bill for the x-ray with the appropriate mod?
 
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amandamkcj

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If you physician owns the equipment and is taking and providing a written reading interpretation of the xray than yes you would capture as global without the 26 or TC modifier.

If your physician sends the patient to another facility who performs and reads the xray than you would not have any Xray to bill.

Based from what I understand if your physician is performing either the 26, TC or global and billing the X-Ray CPT code than you cannot count it under the MDM section in EM as that would be considered double-dipping. IF your physician is NOT billing the XRAY CPT than you can count that under the MDM section in EM.
I hope this is helpful,
Amanda CIRCC, RCC
 

astephens

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adding on to this question, if the physician read the exam for this patient and the next day he sees the patient in his office; can he bill for a new patient visit? if not, where can I find a reference?
Thank you so much for your help.
 
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