Wiki X-Ray billing

[mgarcia400]

Hello all,
I bill for Primary care family practice. We are starting to perform X-rays in office, but they are being read out of office. Can anyone clarify the correct way to bill for when X-rays are read outside office.

I know to apply the appropriate CPT code for actual X-Ray, but what modifiers would need to be added? Can we bill for the X-Rays to be read outside the office?

Any input is appreciated.

 

[csperoni]

There are a couple of different types of arrangements that practices in this situation set up. The primary concern is that it needs to be Stark compliant, so I hope that whatever agreement was set up was properly reviewed by an appropriate person. I am assuming the PCP office owns/leases the xray equipment. And the person physically performing the xray is the PCP or an employee of the PCP legally allowed to perform xrays. The PCP office is then sending the image(s) to a radiologist licensed in the state to provide a formal report of the xrays. Assuming all that, here are some possible agreements the PCP practice and radiology practice may have settled on.
1) PCP bills insurance for all services provided and hires the radiologist to perform the services.
2) PCP bills insurance for the technical component only modifier -TC. Radiologist bills insurance for the reading modifier -26.
3) PCP bills insurance for all services and pays the radiologist (not as an employee) for reading. This is where compliance can get tricky as the amount being paid is subject to anti-kickback regulations.
There may be other types of arrangements that are still compliant, but these are ones I personally have encountered and the agreement was scrutinized by legal on both sides.
Some practices, the PCP will read most of the xrays done and only send out for formal reading if there is a questionable fracture, or a density, or some other type of abnormality.
In my opinion, all of this should have been decided before actually providing the service to a patient.

 

[julesmit]

Hello all,
I bill for Primary care family practice. We are starting to perform X-rays in office, but they are being read out of office. Can anyone clarify the correct way to bill for when X-rays are read outside office.

I know to apply the appropriate CPT code for actual X-Ray, but what modifiers would need to be added? Can we bill for the X-Rays to be read outside the office?

Any input is appreciated.

If they are being read out of office, then no, you cannot bill global. You would apply -TC modifier for the technical component only to the xray code.