ED Coding and Reimbursement Alert

Question: Can we bill for concurrent radiology interpretations?


Illinois Subscriber
Answer: If you-re billing Medicare, and the emergency department physician has provided the service contemporaneously with the patient's care (and documented accordingly), you can bill for radiological interpretations.

The key: Make sure the ED physician provided a complete, separately identifiable written interpretation, and didn't just receive previously interpreted results from the radiologist. If the ED physician performed the work first and the radiologist over-read it after the patient left the ED, you should bill for the interpretation.

If the radiologist interpreted the image and sent a report to your physician, you should include the work involved with the review of that report as part of the evaluation and management service.

In most cases in the ED, the ED physician is on-site and gets first crack at the interpretation, and has earned the appropriate payment for this work. CMS will pay the physician who provides a -separate distinctly identifiable complete written interpretation- at the same time the patient receives treatment, and this is frequently the ED physician.

Worth the trouble: Making the effort to bill for ED radiological interpretations, such as EKGs and after-hours x-rays, is not for small potatoes. Medicare reimburses roughly $10 for a standard chest x-ray. Since radiology services represent a high-volume service, the average income boost for reporting these services could greatly impact your practice.