Wiki Professional Component of Imaging (X RAYS, MRIs)


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We have been receiving denials on professional component (modifier 26) of imaging codes, when an E&M code is billed on the same DOS. We are being told the imaging is bundling with the E&M, and that it is included in the E&M.

Our physician is not the first physician to review the Imaging, however. So, for example, a patient will come in with an X-ray that was done and evaulated by a different physician the previous week, and our physician will review it and make his own determination, in written form, about what this imaging indicates.

Per the Medicare claims manuel, Chapter 13 Section 20.1 It states that the professional component of imaging must be paid as long as a written report is done on that imaging, but it doesn't address whether several physicians can be paid for different reports on the same X Ray.

Any ideas/help on this?:confused:
My understanding is that only the physician that reads the films to give the initial intrep of the test would bill the physician component (-26 modifier). Any other subsequent readings (another physician reviewing the film) would build that into his MDM of the EM visit such as ordering tests from radiology section or reviewing original films or tracings. He would get credit for the work but only in the EM visit. I've never heard of a physician charging for the intrep after the film has already been read once except in maybe the rare occasion where the ordering physician asks for another opnion. We perform CT's in our office and only charge the Technical Component. The CT is sent to a radiologist for report and he bills the -26. When the patient comes back, our physicians look at the CT personally and write a report, but they don't bill the -26 again-they build that into the MDM section of their EM visit. Make sense?? Hope that helps!