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Professional component of radiology services

dokeef01

Contributor
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21
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0
Hello,

If a provider, say a pedatric doctor, performs an x-ray in the office can they bill the total component with a notation in the notes- x-ray of the knee- normal? Or do they need to have a separate report?

Thanks,
Deborah
 

AuntJoyce

Guru
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169
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0
Professional component on x-rays

Hi Deborah,

Actually, in order to bill the full charge (technical and professional), your doc would have to be a radiologist in addition to being a pediatrician.

I worked for an Orthopaedic Surgeon for 15 years and he owned all the equipment...so, he paid for the all the supplies and paid an x-ray technician. We soon found out that he was only entitled to 2/3 of the total charge (without appending TC or 26) simply because he was not a radiologist. It does not matter that these docs can actually read x-rays - they are just not allowed to render an official report of the reading if they are not radiologists.

Hope this helps...bottom line - bill for the entire ball of wax but expect at least a 1/3 reduction.

Good luck :)

Joyce:cool:
 

JMeggett

Guru
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226
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Hi Deborah,

Actually, in order to bill the full charge (technical and professional), your doc would have to be a radiologist in addition to being a pediatrician.

I worked for an Orthopaedic Surgeon for 15 years and he owned all the equipment...so, he paid for the all the supplies and paid an x-ray technician. We soon found out that he was only entitled to 2/3 of the total charge (without appending TC or 26) simply because he was not a radiologist. It does not matter that these docs can actually read x-rays - they are just not allowed to render an official report of the reading if they are not radiologists.

Hope this helps...bottom line - bill for the entire ball of wax but expect at least a 1/3 reduction.

Good luck :)

Joyce:cool:
Hi Joyce ~ I am looking for this information in writing from an Authoritative source to provide for my providers. Can you please share where you've seen this about having to be a Radiologist in order to bill xrays without modifiers? Thank you for your help,
Jenna
 

AuntJoyce

Guru
Messages
169
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0
Hi Jenna,

I will contact the office that I worked in at the time - that was when I lived in New York. They have all those records that I had put together (back int he early 80's). As soon as I have this information, I will surely share it with you. In the meantime, I will look to see if I can replicate it anew.

Thanks!

Joyce
 

dokeef01

Contributor
Messages
21
Best answers
0
Hello Joyce,

I have never heard of that. To me that sounds more like a payor issue than a coding issue. My interpretation of x-ray coding is that when a provider bills the professional component or total component, there has to be a separate report. I was not sure of this and that is why I am questioning it.

Thanks again,

Deborah
 
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