2nd Interpretation
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http://www.umd.nycpic.com/faq-Radiology.html#Q1
. Can radiologists provide interpretation of a radiology film(s) as a second opinion when requested by another physician? (Last Reviewed: February 25, 2008)
Medicare guidelines for payment of a second interpretation may be found Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, §100. The guidelines state:
“Generally, carriers must pay for only one interpretation of an EKG or x-ray procedure furnished. They pay for a second interpretation (which may be identified through the use of modifier -77) only under unusual circumstances (for which documentation is provided) such as a questionable finding for which the physician performing the initial interpretation believes another physician's expertise is needed or a changed diagnosis resulting from a second interpretation of the results of the procedure.”
In the radiology section of the Current Procedural Terminology (CPT) Manual, procedure code
76140 is found and has the description “Consultation on x-ray examination made elsewhere.” However, on the Medicare Physician Fee Schedule Database (MPFSDB), code
76140 has a status indicator of “I” – not valid for Medicare purposes. Therefore, when you submit a claim for a second interpretation performed, you may bill the service as follows:
- Code 76499 – unlisted radiographic procedure
- Modifier 26 – to represent that your billed amount represents the professional component of the service
- Modifier 77 – to represent repeat procedure by another physician
Claims billed with unlisted code
76499 will suspend to the Medical Review Department and will be medically reviewed and manually priced, if medical necessity is substantiated in the clinical record.