Wiki xrays with office visits

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cindy_b

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Hi Everyone,
Please advise. Since when are x rays considered part of an evaluation and management? I have been coding for 15 years in Orthopedics and I have never had a denial for an x ray as included in the E&M code until now. Humana has denied 3 x rays that I billed. All were on the same patient, but on different dates of service. I can't help but think the 26 modifier I appended to the x rays has something to do with it, as the patient was in a SNF. However, when I called, I was told it was because I also charged for an office visit. I was told to send proof from the AMA guidelines that these two should not be bundled. I don't know where to get this information. Can anyone tell me?

Thank you,
Cindy Chalk, CPC
 
We had the same issue and we too were scratching our heads. First of all, you need to call customer service and speak to a supervisor or someone in provider relations. After we pointed this error in claims processing out, they had to correct a lot of claims. So maybe we or another group has done some good work for you. The AMA can't tell you if procedures are bundled. They only tell you what constitutes the codes that they publish. Critical Care is a good example. The AMA clearly defines what they bundle into that code and what they don't. You can print the NCCI edits which will clearly show that X-rays are never bundled with the E/M.
 
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