Radiology CPT 76140

[MELANIEESTRELLA]

Can this code be appropriately billed in an orthopedists office, if a patient is sent to us for a consultation and brings a x-ray without interpretation?
Thank you,
Melanie Estrella

 

[mhstrauss]

Can this code be appropriately billed in an orthopedists office, if a patient is sent to us for a consultation and brings a x-ray without interpretation?
Thank you,
Melanie Estrella

We've gone in circles in my clinic about 76140. After much reading through Medicare, ACR, and various other resources, my opinion is that looking at an Xray is part of of the E/M visit. He can do his own interp and get 2 points in the "amount of data reviewed" part of the E/M service. But should not bill separately for reviewing imaging.

Just my $0.02!!

 

[JuliaAMiller]

Additional Question

Scenario: Patient is seen on an emergent basis in Mexico and has ultrasounds performed. The patient returns to the US and brings ultrasound images back with him. The patient gives the ultrasound images to his PCP. The PCP then gives the radiologist the images, and the radiologist writes a report. Thus, the radiologist is not billing for the appropriate E&M...do we...
A) Bill Medicare with the 76140 which they do not cover and will deny, or
B) Bill with the ultrasound CPT code with the 26 mod, as the radiologist did not use his equipment, just used his professional opinion to interpret the ultrasound.

Thoughts? I am also in need of a Medicare policy regarding this and haven't been able to find one.

 

[thomas7331]

Scenario: Patient is seen on an emergent basis in Mexico and has ultrasounds performed. The patient returns to the US and brings ultrasound images back with him. The patient gives the ultrasound images to his PCP. The PCP then gives the radiologist the images, and the radiologist writes a report. Thus, the radiologist is not billing for the appropriate E&M...do we...
A) Bill Medicare with the 76140 which they do not cover and will deny, or
B) Bill with the ultrasound CPT code with the 26 mod, as the radiologist did not use his equipment, just used his professional opinion to interpret the ultrasound.

Thoughts? I am also in need of a Medicare policy regarding this and haven't been able to find one.

This particular scenario would be excluded from Medicare coverage because a part of the service was performed outside of the U.S. (See Chapter 16 of the Benefit Policy Manual).

If the ultrasound had been done in the U.S., the radiologist could bill for the interpretation, or the provider could bill for it if they purchased the service from the radiologist. lled another provider. This is discussed in a little more detail in Chapter 13 of the Medicare Claims Processing Manual, see sections 20 - Payment Conditions for Radiology Services, and section 100 - Interpretation of Diagnostic Tests: https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c13.pdf