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Thread: MRI - Professional Component?

  1. #1
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    Arrow MRI - Professional Component?

    Auditing some accounts for my Ortho doc, there are some in which the doc selects only an E/M charge on the superbill. But, upon closer look at the documentation I see notes such as, "The patient is here for followup of the MRI scan of his right shoulder. Review of the scan demonstrates a massive rotator cuff tear. There is thinning of the tendinous structures, retraction to the glenoid and evidence of some atrophy of the muscle." Would this be enough to justify billing a professional component of this MRI?

    Thanks.
    Bill Hale, CPC

  2. #2
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    Default

    Bill...You caught my interest on this question. I would think no. Here's my opinion. Our neurosurgeons work on a referral basis only. Prior to a patient being scheduled for an appointment, the neurosurgeons review MRI's, CT's, etc...This allows them to ascertain if the patient needs to be seen. The MRI/CT has already been read by another MD and he/she has provided his/her medical analysis; however, due to the nature of our neurosugeons business, they prefer to interpret the results in order to "head off" an un-needed patient visit. I am curios what others will say............

  3. #3

    Default Tried without success.

    I work in neurology and we have had the same experience. We tried billing for the MRI interp but when we billed first the hospital contracted radiologist could not get paid. Most carriers will only pay for one reading. We decided that we should stop billing for the interp even though we could. When it is documented in your consult that the doctor re-read the MRI it can help increase you E&M level.

  4. #4
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    Chennai
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    Thumbs up MRI review

    its inclusive in E&M, medical records records review under the medical decision making (MDM),dr bill only E&M service,
    Dr.Jeevanantham Mariappan PT.,MD (A.M).,CPC.,
    Six Sigma - GB

  5. #5
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    There can be only one official interpretation of any radiology service. The professional component goes to the physician that provides the official written report. A radiology interpretation cannot be in the patient's progress notes it must be a separate radiology interpretation.

  6. #6
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    Default question

    Quote Originally Posted by mitchellde View Post
    There can be only one official interpretation of any radiology service. The professional component goes to the physician that provides the official written report. A radiology interpretation cannot be in the patient's progress notes it must be a separate radiology interpretation.
    I was under the impression that any physician could re-read a radiology report as long as there was an interpretation in the medical record and could be paid for it, with the correct modifier of course. Is this not correct?

  7. #7
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    That is not correct, a re read would be considered part of the E&M decision making component. The 26 modifier is for use by the physician that provides the ofiicial interpretation report. If that physician does not own the equipment he bills with the 26 if he does own the equipment and provides the report he may bill the global code with no modifier.

  8. #8
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    Default Mri

    Quote Originally Posted by mitchellde View Post
    That is not correct, a re read would be considered part of the E&M decision making component. The 26 modifier is for use by the physician that provides the ofiicial interpretation report. If that physician does not own the equipment he bills with the 26 if he does own the equipment and provides the report he may bill the global code with no modifier.
    Well, this directly contradicts the way I was trained, so I guess it looks like I have some research to do. Thanks for your input. I appreciate it.

  9. #9
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    I always spread cheer and happiness wherever I go! Look on the AMA website also at CMS... and even to some extent in the CPT book although it is not as clearly stated. I was called in as a consultant for 4 different ortho clinics when they were audited for this and it did not work out so well for them, they had to pay back a ton of money both Medicare and commercial audits. It was discovered in every case after the payer discovered they were paying a radiologist and the ortho physician for the same interpretation. I hope this helps is some small way.

  10. #10
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    Anna,

    Out of curosity...are you speaking about CPT code 76140? I have a provider that bills for this but rarely paid. I'm wondering if anyone receives payment for this.

    76140=Consultation on X-ray Examination Made Elsewhere

    CPT code 76140 Consultation on x-ray examination made elsewhere, written report is intended to be used when, for example, Doctor "A" from Sunnydale Hospital sends a radiograph taken at Sunnydale Hospital to Doctor "B" at Goodhope Hospital. Doctor "A" asks Doctor "B" to offer his opinion on the radiograph. Doctor "B" writes a formal report on his interpretation of the radiograph and sends a copy of this report to Doctor "A."

    This code is not intended to be used by physicians within the same institution to reread radiographs taken at that institution. Levels of Service (limited, intermediate, extended, comprehensive) include the "evaluation of appropriate diagnostic tests" which may necessitate the attending physician to personally review the radiographs taken on his patient.

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