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Thread: X-ray With Modifier 26

  1. #1
    Join Date
    Apr 2007

    Default X-ray With Modifier 26

    AAPC: Back to School
    Hopefully I Can Explain My Question Clearly.

    Say You Have A Practice With X-ray Equipment, And They Take
    X-rays And Interpret Them By Outsourcing Them To A Radiologist That Works For Them. In Other Words They Bill The Whole Global Charge For The X-ray Using The Appropriate Cpt.

    Now My Question Is, Next Door To This Practice Is Another Family Practice (different Group). I Work For Them.

    Say This Practice Sends A Patient Next Door To Get An X-ray Done, And Then This Patient Comes Back Two Days Later With His/her Films To Be Read. Meaning A (wet Read). Do We Bill A X-ray With A Modifier 26, Or Just An E/m Visit.

    Confusion Lies In, The Practice With The X-ray Equipment Is Going To Bill The Whole Global Fee, So Are We Aloud To Bill Out A Modifier 26.

    Is That In Compliance.



  2. #2
    Join Date
    Apr 2007



    I think you posted this a few days ago.

    All you can capture is the E/M visit. Your doctor had nothing to do with the films. The were taken elsewhere and read officially elsewhere.

    When a patient brings films with them to your office and your doctor is looking at them, this is part of the E/M visit.

    Please review the e/m guidelines in your CPT book for further instruction


  3. #3
    Join Date
    Apr 2007


    I agree with what you said, but I got another response saying I can bill the
    X-ray with modifier 26 with an E/M if they address the acute problem justifying the E/M.

    So is there any specific guidelines pertaining to modifier 26. I know reading of an x-ray is included in the MDM of the E/M guidelines.

    But let's say you have a patient who has a servere cough.The physician address the problem, and writes a prescription. Also referrs them next door for an x-ray. Because we don't have x-ray equipment here. For this visit I bill the E/M.

    Now the patient, the next day goes to get the x-ray. Comes back to the original practice (which is us) to get the x-ray's read. Physician reads the x-ray and sees the patient has pnemonia. Treats the problem.

    So can I bill an E/M 992XX- with 486
    and a 71020-26- 486

    Is there any guidelines saying this would be incorrect.

    My coding instinct says this would not be right. But if there's no guidelines on this being incorrect. Then why wouldn't one bill this out this way. More reimbursement for the physician.


  4. #4
    Join Date
    Apr 2007
    Madison Area Chapter in Madison WI


    This might help. The person who read (interpreted) and wrote the radiology report is the person who get "credit" for the 26 portion.

    Reviewing the xray would be included in the E/M components. Reviewing is different than interpreting and writing the report.
    Happy Coding, Claudia

    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    ccrsconsulting.com - website

  5. #5
    Join Date
    Apr 2007


    ditto to Claudia's response.

    Your doctor is mearly reviewing the x-ray. He is not doing the official "reading" of it.

    The radiologist reading it is the one that will get the -26 component and the facility taking the films is getting the TC. Therefore there are no components left for you to bill.

  6. #6
    Join Date
    Apr 2007


    Alright now, great responses. I think I'm an expert now. (lol). When it comes to this question.

    Thank You
    Daniel, CPC

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