To bill for the reading and interpretation of any test, the provider must write a report. Reading someone else's report and signing off on it is a not a billable service by itself.
So he bills for the interpretation of an EEG. Where is his interpretation? Where is the proof that the procedure (the interpretation) was performed? What does he think will happen if the insurance company audits him and asks for the EEG report... is he going to send someone else's report with the words "I concur" and his signature and think that is going to be sufficient??
When a doctor tells me that other doctors "do it all the time", I offer him the number for the fraud hotline for the medical board, and ask him if he would like to turn someone in. I also tell him that he is too pretty for prison, and when he tells me that people don't go to prison for [whatever], I pull up articles showing him that providers do indeed go to prison for whatever hare-brained scheme someone has just about talked him into.
You can find this statement, and similar statements, in many places:
The professional component represents the supervision and interpretation of a procedure that is furnished to an individual patientwhichresults in a written narrative report included in the patient's medical record. An interpretation and report should address the findings, relevant clinical issues, and comparative data (when available). Billing for the professional component based on a review of the findings of these procedures, without a complete, written report similar to that which would be prepared by a specialist in the field, does not meet the conditions for separate payment of the service. The review is already included in the evaluation and management (E/M) payment. For example, a notation in the medical records stating“EKG-normal”or “Chest x-ray normal” would not suffice as a separately payable interpretation and report of the procedure and should be considered a review of the findings payable through the E/M code.
American College of Radiology (ACR) guidelines suggest that physicians and other qualified health care professionals who believe the Professional Component (modifier 26) for a PC/TC Indicator 1 radiology code is reimbursable in addition to the E/M service on the same day include the following information in the medical record
rocedures and materials•The report or record should include a description of the studies and/or procedures performed and any contrast media and/or radio-pharmaceuticals (including specific administered activities, concentration, volume, and route of administration when applicable), medications, catheters, or devices used, if not recorded elsewhere.Findings•The report or record should use appropriate anatomic, pathologic, and radiologic terminology to describe the findings.Impression •Conclusion or diagnosis
