Wiki Second reading of an MRI -26

[cmedina]

To all who can answer this question:

Our ortho ordered an MRI... the interpretation & MRI films are received... the physician would like to append the -26 modifier to the MRI code for reading the MRI.. is this acceptable after we receieved the interpretation? I am confused because I am getting different answers from everyone, 2 of the 3 claims that were billed were paid (Medicare & NJBS). Any advice would be greatly appreciated.

Also, I just spoke with NJ Medicare & they informed me that a second reading is payable with the -26 modifier & a repeat modifier. I asked the question in every possible way, and they informed me that the payment was correct. Can anyone give me some feedback on this scenario.

Thank You

 

[mitchellde]

I am not sure what they were answering but the generally accepted response here is no only one official interpretation is allowed, that is the interpretation that has the Radiology report signed by the physician. An over read by your physician is not to billed with the 26. You can however use his documentation of his personal review of the films/CD to augment possibly his visit level as that is an element of complexity in the decision making component of the visit level.
Debra Mitchell, MSPH, CPC-H

 

[SCanterbury]

According to Medicare, a second interp is allowed, but only in special circumstances and when medically necessary.

Note that the following quote mentions an ER physician trying to bill an interp on top of a Radiologists interp, but the same principles should apply in your situation.

Medicare Claims Processing Manual
Chapter 13
Section 100.1

Carriers generally distinguish between an “interpretation and report” of an x-ray or an EKG procedure and a “review” of the procedure. A professional component billing based on a review of the findings of these procedures, without a complete, written report similar to that which would be prepared by a specialist in the field, does not meet the conditions for separate payment of the service. This is because the review is already included in the emergency department evaluation and management (E/M) payment. For example, a notation in the medical records saying “fx-tibia” or EKG-normal would not suffice as a separately payable interpretation and report of the procedure and should be considered a review of the findings payable through the E/M code. An “interpretation and report” should address the findings, relevant clinical issues, and comparative data (when available).

Generally, carriers must pay for only one interpretation of an EKG or x-ray procedure furnished to an emergency room patient. They pay for a second interpretation (which may be identified through the use of modifier “-77”) only under unusual circumstances (for which documentation is provided) such as a questionable finding for which the physician performing the initial interpretation believes another physician’s expertise is needed or a changed diagnosis resulting from a second interpretation of the results of the procedure.

Seth Canterbury, CPC, ACS-EM