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ER Physician Billing Diagnostics

  1. Default ER Physician Billing Diagnostics
    Medical Coding Books
    I have recently run across a situation where the ER doctor is not only billing a E/M code, but also the x-ray codes with modifier 26. However, I'm also receiving bills from the radiologists billing for the same DOS and same x-ray code with the modifier 26. The notes 9/10 list the radiologist's name. Our system sees these as duplicates. My question is, can a ER doctor bill for the x-ray or should those charges be included in the E/M code or should we process them as adjustments?

    Note: The OP hospital bills the diagnostic, which is considered the TC and is paid for without a problem.

  2. #2
    Default
    Is your ER doctor dictating a report for the x-rays?

    There is no reason the ER doctor couldn't bill for the reading if they are doing it and dictating a report. The question is, if that is what is happening why is a radiologist then coming in and reading as well?

    My personal experience with ER and urgent care was the physicians looked at the x-rays but did not dictate reports and therefore did not charge for the readings. The radiologist came in and did the official read and report and billed for it.

    There appears to be some overlap in the process or misunderstanding of who is or should be doing what.

    Good luck,

    Laura, CPC, CEMC

  3. Default
    My bet is the ER physician is billing inaccurately. I would pend the claim and request a copy of the radiology report from the ER physician AND the radiologist and decide from there. If you look at the notes in CPT at the beginning of the radiology section there is a section titled "Written reports". "A written report signed by the interpreting physician should be an integral part of a radiological procedure or interpretation". This one has been a war between the two sides for quite some time, but realistically on a claims payment basis, only one of them gets paid for professional component.

  4. Default
    Thanks for the quick response. Per the ER and diagnostic notes, its listing the radiologists name on the diagnostic reports, I haven't been seeing the ER doctor as even reading the x-rays.

    Just a side note, I'm not doing the coding, I'm on the other end receiving and processing these bills from the ER doctor, radiologists, etc.

  5. #5
    Default
    the treating physician is giving a wet reading which is not reimbursable. -26 means the physician interpreting the diagnostic reading writes a report as well. NO REPORT, NO -26.
    hope this helps

    Quote Originally Posted by Miax0328 View Post
    I have recently run across a situation where the ER doctor is not only billing a E/M code, but also the x-ray codes with modifier 26. However, I'm also receiving bills from the radiologists billing for the same DOS and same x-ray code with the modifier 26. The notes 9/10 list the radiologist's name. Our system sees these as duplicates. My question is, can a ER doctor bill for the x-ray or should those charges be included in the E/M code or should we process them as adjustments?

    Note: The OP hospital bills the diagnostic, which is considered the TC and is paid for without a problem.
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

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