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?
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?