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Separate Documentation for Interpertation

  1. #1
    Madison, WI
    Default Separate Documentation for Interpertation
    Medical Coding Books
    I work for an Othro phy and we are trying to sort out if he should be submitting a separate dictation for the xrays done or if he can include it in his orginal documentation. Any feedback??

  2. #2
    You need to have a radiology report in order to bill the professional component of the X-Ray.

  3. #3
    Columbia, MO
    Nelson is absolutely correct! There must be a separate radiologic interpretation report in the medical record. A student of mine recently relayed that their practice had to refund a significant amount of money to a commercial payer when it was discovered that her docs were pasting the sentence from their office note to a separate document to have that serve as a radiology report, apparently it did not!

    Debra A. Mitchell, MSPH, CPC-H

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