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Billing for 2nd reading of CT or cath

  1. Default Billing for 2nd reading of CT or cath
    Medical Coding Books
    A billing consultant recently told my surgeon that if he reviews a cath or a CT scan on a patient that he is seeing in the office, and then dictates a note reporting his findings, he can bill for that as well as the visit. Regardless of whether someone else has done the study and dictated a report.

    Does this sound correct to anyone else? Is anyone doing this? I thought review of the CT or cath could "count" towards the tests reviewed under the MDM section of the visit but I didn't think we could charge separately for basically re-writing a report.

    Thanks for your help!

    Lisi, CPC

  2. #2
    You are correct. Reviewing a cath or CT scan (any type diagnostic imaging) during an office visit is considered apart of the MDM (amount and/or complexity of medical data to be reviewed).

    I belive your billing consultant is thinking of CPT code 76140, consultation on X-ray examination made elsewhere, written report. Another physician must ask for his advise and opinion on the imaging, whereby he will dictate a note and report his findings. Medicare and Medicaid will not pay for this code, but some private insurances do. It pays rather poorly but he'll get something.

  3. #3
    If he does read the films and dictates his own report he can in fact bill for the professional component of that xray, ct scan, mri, etc..

    Odds of getting paid if someone else already read it, slim to none in most cases.

    I have had cases in the past where a patient brought reports to our ortho surgeons and they were not happy with them, asked for the films and read the films themselves, came up with different findings. We appealed and got our readings paid.

    Laura, CPC, CEMC

  4. Default
    Thank you both for your input.

    Laura, what codes did you use for these services? I couldn't find one for interpretation and report only. Feel free to email me directly at address below if you want.



    Lisi Harkleroad CPC
    Coding & Billing Analyst
    Division of Cardiothoracic Surgery
    Northwestern Medical Faculty Foundation, Inc.
    (312) 695-2033

  5. #5
    You would use whatever the service was and just add the 26 modifier.

    So for example the CT scan was of the thorax w/o contrast materials you would submit 71250-26.

    The reimbursement is not so great, most of the money on these is for the technical component, but hey if they did it and documented it you should try and get what you can.

    Just be sure they have dictated a report on the films and not just reviewed and summarized/reworded a report by someone else. Odds are you will have to send in documentation for review or appeal.

    Good luck,

    Laura, CPC, CEMC

  6. Default
    Uh. I never thought of that. I'm used to putting a -26 on things like an intraop TEE because we don't own the equipement but my physician is doing the work. I never thought of using it when they are reviewing an outside film...

    Ok, thanks so much for the info Laura.


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