X-ray With Modifier 26, Or E/m


True Blue
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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


Killeen, TX
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Does your physician's office not have have x-ray equipment to perform radiological services? If not, then the office that is performing the x-ray can only code the 70000 series code with a -TC component, only. An E&M is not medically necessary for that type of visit. The provider that orders the test can code the 70000 series with modifier -26 for the professional componet and an E&M level for the acute visit.