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. 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, Â§100. The guidelines state:
â€śGenerally, 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 physicianâ€™s expertise is needed or a changed diagnosis resulting from a second interpretation of the results of the procedure.â€ť
In the radiology section of the Current Procedural Terminology (CPT) Manual, procedure code 76140 is found and has the description â€śConsultation on x-ray examination made elsewhere.â€ť However, on the Medicare Physician Fee Schedule Database (MPFSDB), code 76140 has a status indicator of â€śIâ€ť â€“ not valid for Medicare purposes. Therefore, when you submit a claim for a second interpretation performed, you may bill the service as follows:
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.
- Code 76499 â€“ unlisted radiographic procedure
- Modifier 26 â€“ to represent that your billed amount represents the professional component of the service
- Modifier 77 â€“ to represent repeat procedure by another physician
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