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Professional component of radiology services

  1. #1
    Default Professional component of radiology services
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    Hello,

    If a provider, say a pedatric doctor, performs an x-ray in the office can they bill the total component with a notation in the notes- x-ray of the knee- normal? Or do they need to have a separate report?

    Thanks,
    Deborah

  2. Default Professional component on x-rays
    Hi Deborah,

    Actually, in order to bill the full charge (technical and professional), your doc would have to be a radiologist in addition to being a pediatrician.

    I worked for an Orthopaedic Surgeon for 15 years and he owned all the equipment...so, he paid for the all the supplies and paid an x-ray technician. We soon found out that he was only entitled to 2/3 of the total charge (without appending TC or 26) simply because he was not a radiologist. It does not matter that these docs can actually read x-rays - they are just not allowed to render an official report of the reading if they are not radiologists.

    Hope this helps...bottom line - bill for the entire ball of wax but expect at least a 1/3 reduction.

    Good luck

    Joyce

  3. Default
    Quote Originally Posted by AuntJoyce View Post
    Hi Deborah,

    Actually, in order to bill the full charge (technical and professional), your doc would have to be a radiologist in addition to being a pediatrician.

    I worked for an Orthopaedic Surgeon for 15 years and he owned all the equipment...so, he paid for the all the supplies and paid an x-ray technician. We soon found out that he was only entitled to 2/3 of the total charge (without appending TC or 26) simply because he was not a radiologist. It does not matter that these docs can actually read x-rays - they are just not allowed to render an official report of the reading if they are not radiologists.

    Hope this helps...bottom line - bill for the entire ball of wax but expect at least a 1/3 reduction.

    Good luck

    Joyce
    Hi Joyce ~ I am looking for this information in writing from an Authoritative source to provide for my providers. Can you please share where you've seen this about having to be a Radiologist in order to bill xrays without modifiers? Thank you for your help,
    Jenna

  4. Default
    Hi Jenna,

    I will contact the office that I worked in at the time - that was when I lived in New York. They have all those records that I had put together (back int he early 80's). As soon as I have this information, I will surely share it with you. In the meantime, I will look to see if I can replicate it anew.

    Thanks!

    Joyce

  5. #5
    Default
    Hello Joyce,

    I have never heard of that. To me that sounds more like a payor issue than a coding issue. My interpretation of x-ray coding is that when a provider bills the professional component or total component, there has to be a separate report. I was not sure of this and that is why I am questioning it.

    Thanks again,

    Deborah

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