AAPC - Back to school
Results 1 to 2 of 2

Thread: Interpretation of Films

  1. #1

    Default Interpretation of Films

    AAPC: Back to School
    It has been several years since I worked in Radiology and was recently asked the appropriate CPT Code to use for an interpretation of films by another
    Radiologist than the one who initially interpreted the films. How should this best be coded?

  2. #2
    Join Date
    Apr 2007

    Default 2nd Interpretation

    You might find this helpful


    . Can radiologists provide interpretation of a radiology film(s) as a second opinion when requested by another physician? (Last Reviewed: February 25, 2008)

    Medicare guidelines for payment of a second interpretation may be found Pub. 100-04, Medicare Claims Processing Manual, Chapter 13, §100. The guidelines state:

    “Generally, carriers must pay for only one interpretation of an EKG or x-ray procedure furnished. They pay for a second interpretation (which may be identified through the use of modifier -77) only under unusual circumstances (for which documentation is provided) such as a questionable finding for which the physician performing the initial interpretation believes another physician’s expertise is needed or a changed diagnosis resulting from a second interpretation of the results of the procedure.”

    In the radiology section of the Current Procedural Terminology (CPT) Manual, procedure code 76140 is found and has the description “Consultation on x-ray examination made elsewhere.” However, on the Medicare Physician Fee Schedule Database (MPFSDB), code 76140 has a status indicator of “I” – not valid for Medicare purposes. Therefore, when you submit a claim for a second interpretation performed, you may bill the service as follows:
    • Code 76499 – unlisted radiographic procedure
    • Modifier 26 – to represent that your billed amount represents the professional component of the service
    • Modifier 77 – to represent repeat procedure by another physician
    Claims billed with unlisted code 76499 will suspend to the Medical Review Department and will be medically reviewed and manually priced, if medical necessity is substantiated in the clinical record.

Similar Threads

  1. re-read of films
    By RADCODER in forum Interventional Radiology
    Replies: 10
    Last Post: 06-28-2012, 02:45 PM
  2. Spot Films
    By michaelrcpc in forum Interventional Radiology
    Replies: 0
    Last Post: 03-20-2012, 03:58 PM
  3. Interpretation of Films
    By cheribaby in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 05-12-2008, 12:49 PM
  4. OR Films
    By coder16 in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 12-25-2007, 01:37 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.