Wiki Two docs read same xray

[Linda McMann]

We have an orthopedist who wants to bill for a second reading of any xray, mri, ct that a patient brings in. He has disagreed with the radiologist's interpretation on some. How do we code and bill for this? I see there is a modifier '77', but would it raise a red flag if he re-interprets all these radiology procedures? And does anyone have any guidelines in this matter? Any and all help will be appreciated.

 

[CodingKing]

No. It falls under the E&M "AMOUNT AND/OR COMPLEXITY OF DATA TO BE REVIEWED"

Discussion of contradictory or unexpected test results with the physician who performed or interpreted the test is an indication of the complexity of data being reviewed. On occasion the physician who ordered a test may personally review the image, tracing or specimen to supplement information from the physician who prepared the test report or interpretation; this is another indication of the complexity of data being reviewed.

 

[thomas7331]

There's a good discussion of this in the Medicare Claims Processing Manual, Chapter 13, section 100.1 which you can find here:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/clm104c13.pdf

This discusses specifically an interpretation done by an emergency room physician and the radiologist, but the concept is the same. There are limited situations, described here, where Medicare will consider a second interpretation and report billed with modifier 77. But I generally agree with the post above - except in unusual circumstances, it would not be appropriate to bill for a second interpretation simply because the provider disagrees with the radiologist report - that doesn't necessarily justify a separate report, but is more akin to a review of the findings where the provider is making a clinical correlation of those findings to the patient's condition, which is more appropriately captured in the E&M component.