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Radiology-26 referral?

  1. Default Radiology-26 referral?
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    I bill for a hospital based,reading radiologist. Medicare denied a cxr, saying it's because the referring physician was a chiropractor. I was told to resubmit the charge & put my Dr. as the referring. My Dr. happened to be out during that timeframe & I was billing with a -Q6. How can he be the referring Dr. when he wasn't there & can a reading rad self-refer unless it is to order a more thorough test because they see a problem?

  2. #2
    Location
    Columbia, MO
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    Why did you use the Q6 modifier?

    Debra A. Mitchell, MSPH, CPC-H

  3. Default Radiology-26
    Because it was a locum tenum situation- my Dr. was out & a virtual rad was filling. I billed all MCR claims(with -Q6) & the hospital billed for all other insurances.

  4. Default
    Why not use the attending physician or the patients PCP?

  5. Default Chiro referral for cxr
    It was ordered as outpt, so there was no attending Dr. Also, it was ordered by the pt's chiropractor- I don't see how I can put the PCP on the charge if the PCP was not involved.

  6. #6
    Location
    Columbia, MO
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    you may need to get into this insurance particulars regarding chiropractors. Many ins plans do not cover services performed or ordered by chiropractors.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    North Carolina
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    3,126
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    Quote Originally Posted by mitchellde View Post
    you may need to get into this insurance particulars regarding chiropractors. Many ins plans do not cover services performed or ordered by chiropractors.
    I agree-Medicare does not allow Chiro's to order xrays...

    http://www.cms.gov/MLNMattersArticle...ads/SE0416.pdf

  8. Default Chiro referral for xray
    I agree with the chiro situation, but I really need to find out what MCR regs say about making my Dr.(reading rad, who was out of the country at the time) the referring Dr.

  9. #9
    Location
    Columbia, MO
    Posts
    12,570
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    I say no you cannot do this as he was not the referring doctor. If this payer does not allow for a chirpractor to referr for xrays then you cannot bill this service.

    Debra A. Mitchell, MSPH, CPC-H

  10. Default Chiro referral
    I agree. Do you know where I could find specific policy on this?

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