Wiki Radiology Billing - ordering physician

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vnorman

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:confused: Our group has been in negotiations with a radiologist for coverage and over reads. He currently works for other places as well and I have found that the other clinics do not bill using the radiologist as the rendering for any of the radiology services. They bill these services (globally) under the ordering physician. I did not think that was the correct method for billing, however my medical director now wants to pursue this method of billing if possible. Can anyone tell me if this is an allowable way of billing for radiology services? :o

Thanks!
Valarie, CPC
 
Hay Valrie, we are having this same issue. I have written to Medicare under the freedom of information act and nothing in their regulations spell out how to bill for this situation. I agree with you, since the rendering provider is not part of your group you cannot bill using his NPI. The ordering provider did not provide the service but is being charged by the rendering physician for the reading. It is a catch 22 situation.

I will be very interested in hearing how others handle this. So far, we are not billing globally for services.

TJ
 
TJ,

Please keep me updated with the progress of this if you dont mind. I will be very interested in the out come. I dont want to start billing under the referring as I just dont feel it is the proper way to bill. Thanks so much!

Valarie
 
I am not sure if anyone will review this thread at this point since I am posting this in 2024. I just started working for a multi-specialty physicians practice, which includes a radiology dept. The radiology coders there have told me that for all insurances except a certain four, we are supposed to bill the "servicing provider" they take this to mean the provider who ordered the test. For example they are billing out CT scan codes under a Urologist but the CT report was done by a different doctor. This does not seem correct to me, the last practice I worked for we billed the radiologist only for radiology codes ( with the exception of our ASC of course sometimes Dr's are using x-ray or US during a procedure for guidance). The new practice I work for is billing the ordering provider and being denied because they are obtaining Authorization for tests under a radiologist so when we bill the Auth under a Urologist the specialties doesn't match and the service is denied. When I stated I think that they are interpreting "servicing provider" wrong, they told me that technically the rad techs perform the test, the radiologist read the results and the ordering physician is the one is considered the servicing provider. I just completed my CPC course and the passed the test in July of this year so I am a very new coder but this does not seem to follow what we were taught in the course. I am looking for any kind of article or entry from AAPC or CMS regarding the guidelines for billing radiology and who is considered the servicing provider. If anyone see's this and has any links or thoughts please reach out! Of course if you think I am overcorrecting and that this is how it should be billed feel free to let me know that as well.
Thank you for your time
 
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