EM Coding Alert

Question: I work in a new ob-gyn practice with a new provider/specialty: a urogynecologist specializing in pelvic reconstruction. She would like to read her own anorectal manometry (91122-26). One of her patients will have a pelvic reconstruction done at another location/hospital by a physician not in our practice. Our provider wants to read/interpret their reports. Is this billable? If the patient comes to the office, can we bill for the E/M in addition to the reading/interpretation?

California Subscriber

Answer: You cannot report  91122 (Anorectal manometry) with modifier 26 (Professional component) for this “unless she was the only provider who is billing for the interpretation,” warns Melanie Witt, RN, CPC, MA, an independent ob-gyn coding expert based out of Guadalupita, N.M. “If the provider who performed the manometry billed the code with no modifier, the interpretation has already been done.” 

Instead of 91122-26, you would report the appropriate level of E/M service based on the documentation provided, if you determine your provider did perform a separately billable service. “She can only take credit for this under the area of medical decision making — data review — and she must document not only the medical need for do this re-interpretation, but actually prepare a note that includes a description of her ‘independent’ opinion,” Witt explains. 

A second review might be needed, for example, if the original interpretation was unclear or inconclusive or the patient continues to have symptoms that are not explained in the original interpretation.