Wiki Radiology charge billed under PCP

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emmar85

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Dunnellon, FL
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We are a large family practice/ multispecialty office that owns all our radiology equipment. We have about five radiologist that are all joined to our practice and we bill as a group. If a PCP sees the patient and orders an X-ray do we have to send the X-ray charge out on a claim with the radiologist name and NPI? We know this will result in the patient having two copays for that date of service. I can't seem to find a clear answer on the topic.
 
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If the PCP is only ordering the x-ray, and a radiologist is supervising the test and doing the interpretation and report, then it should be billed under the radiologist.

This shouldn't result in a second copay for the patient - x-rays don't usually have copays under most insurance plans. If the patient has a coinsurance or deductible rather than a copay, then it's going to be the same patient responsibility regardless of which provider is billing it.
 
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mdenny73 said:
What about if the radiologist is off-site and only reads the testing. Do we bill under the PCP?
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Haven't coded radiology in years, but if the PCP is only supervising the test, and the off-site radiologist is only interpreting the test, I would split bill this with -TC and -26.
 
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if the ordering physician and the radiologist are own by the same group and billing the same group, no TC or 26 modifer is necessary-that os wat i have found-we are getting ready to do inhouse xrays so i have been trying to research-AAPC has a talking paper on that, i beleive
 
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