X-ray With Modifier 26, Or E/m


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Say You Have Two Different Practice Next To One Another. Not The The Same Grp. Both Family Practices.

Patient Comes In. Sprain Ankle Is Diagnosis And The Physician Does The Whole Work Up And Documents The E/m Service. The Physician Then Sends The Patient Next Door To Get The X-ray Done On The Ankle. We Bill For The E/m Service For This Visit.


Couple Days Later The Patient Comes Into The Original Practice They Were Seen, And The Physician Interprets The X-ray And Then Sends Them To Are Ortho Specialist.

I Bill An E/m For This Service Right. That's My Understanding. But One Of My Collecters Here Says He Has Experience With Billing Out A X-ray With Modifier 26 For This Service. He's Basing This On His Experience Dealing With Er Billing. He Says The Er Doctors Would Bill Out For The X-ray Interpretation With Modifer 26 And An E/m Er Service And The Radiologist Would Also Bill Out The Same Way, Xray And Mod 26.

My Understanding Is The Modifier 26 Is For The Radiologist Interpretation. And The Interpretation Of The X-ray For A Family Physician Is Counted Towards The Medical Decision Making In The E/m Guidelines.

Daneil, Cpc
To Shorten This Up.

The Patient Comes In With Her X-rays And The Physician Reads Them, Determines It's A Possible Fracture. Sends Them To The Ortho With A Refferal. Everthing Is Documented. Does One Bill An E/m For This Visit, Or Does The Physician Bill An X-ray Cpt With Modifier 26. Keep In Mind This Is A Family Practice.

So The Family Physician Is Reading The X-ray.