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Thread: mod 26 and MRIs

  1. #1

    Default mod 26 and MRIs

    AAPC: Back to School
    My CEO is stating that since the pains doctors "read" the patients MRI's that
    the patient brings in I should add the MRI codes with mod 26. I contend that
    since the MRI center has already billed for the professional component we cant bill it. Any one with any references to this would be greatly appreciated

  2. #2
    Join Date
    Apr 2007
    Rochester, NY


    If the radiologist has already billed globally for the exam, you are correct. The insurance will deny your claim as already paid to another provider.
    Thanks, Jill

  3. #3
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    I agree with Jill. However, since they are viewing the actual images, and not just the report from the radiologist, it will count toward amount/complexity of data to be reviewed for Medical Decision Making. That's how I explained to the doctors I worked with that they really were getting "credit" for viewing the images.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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