Wiki Modifier 26

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lorettac

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Hello, trying to get some help on understanding the use of modifier 26.
Our podiatrist states that she can report reading for MRI, if patient is bringing in the MRI disc with images and she read it with discussion during the office visit. For example, a MRI of Left ankle w/o contrast.
Is it correct to report the E&M code with modifier 25 and the MRI code (73721) with modifier 26, LT?
Would this radiology CPT be reimbursable by all medical insurances? Or might need to submit to different payer like DME?
Thank you very much indeed for any information.
 
No you cannot use the 26 modifier for the provider to review the MRI disc. To use the 26 modifier the provider must provide a separate MRI interpretation report that other providers may review and use for diagnostic information. Also If there has already been an interpretation report rendered by the radiologist then you could not provide a second report and bill for it. Reviewing the disc and reporting what you see in the encounter note goes under MDM for the visit level.
 
I agree, and would not recommend doing this. To start with, as Debra mentions, billing for modifier 26 is for the interpretation and report, which is a full and formal review and written report of the MRI, and not the same thing as reviewing images and discussing it with the patient. You can count this toward your data points in the MDM toward the E&M level, but a separate charge isn't warranted just for a review. And second, in most cases, Medicare and many other payers will only reimburse one interpretation of diagnostic imaging studies, and that is paid to the radiologist who reads it and writes the report. If your provider billed, it would like deny as a duplicate, or if it was paid it would cause payment problems for the radiologists. Additionally, I'm not sure if billing for interpretation of an MRI is within the scope of a podiatrist and that's something you may need to consider as well.
 
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