Wiki X-ray billing help!


Mukilteo, WA
Best answers
I'm new to an ASC facility and when it comes to x-rays (almost always performed along with a surgery), I am told that we code professionally with -26 modifier but don't bill at all for the facility side. It was explained to me that x-rays are included in the global surgery package for facilities, so we will only get reimbursed for the professional side of it.

Is this correct? If so, can someone explain this further to me? I thought that for all x-rays if the facilities and doctors split bill, then the doctors append modifier -26 and facilities append modifier -TC and that both will get reimbursed. Or is this not the case when performed along with a surgery?

ASCs and outpatient facilities are usually reimbursed at a case rate for specific classes, or groups, of types of surgeries, so for your payers with this type of reimbursement methods, there will not be an additional payment made for a x-ray performed with a surgery. However, that does not mean that the technical component of the x-ray is not reimbursed - it is just that the payment for it is inclusive in the case rate, which covers any ancillary charges that go along with the surgery. You should still code the facility's charges according to your billing/coding department's guidelines so that you are most accurately reporting the services provided and not omit codes based on expectation of payment.