ED Coding and Reimbursement Alert

Question: If the documentation proves that the ED physician interpreted a patient's x-ray, can I report that, or is a biller on the facility side taking care of it? For example, can I report 9928x-25 and 71010-26 if the physician ordered a chest x-ray and interpreted it as "normal"?


Missouri Subscriber


Answer: In general, you can report x-ray interpretations by the emergency department physician if the x-ray documentation reflects a complete, written report equal to what a specialist in the field would give, and 71010-26 (Radiologic examination, chest; single view, frontal; professional component).

Warning: If the ED doctor is charging for the interpretation, in most circumstances the radiologist can't, and vice versa.

Before you drop the claim, remember that billing for x-ray interpretation can be a hot political issue between ED physicians and radiologists. Check with your physicians and find out their stance on the issue before making the decision. There is no question the ED doctor deserves to be reimbursed for reading films in real time (especially while the radiologist may be off-site), but many ED groups forego the revenue from these services to avoid political troubles.

And interpretation of a chest x-ray as "normal" would probably not be a sufficient reading - so in this case, you might not want to bill. According to Medicare, "an emergency physician may bill for the interpretation and report of an x-ray for a Medicare patient when a 'complete written report similar to that prepared by a specialist in the field' is documented."

Although CMS doesn't outline a specific documentation standard, the agency does state that "the physician must include relevant clinical issues, comparative data, and study findings."

Whether you can report 99285 (Emergency department visit for the evaluation and management of a patient, which requires these three key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: a comprehensive history, a comprehensive examination, and medical decision-making of high complexity) with modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) depends on whether you have the appropriate documentation.