General Surgery Coding Alert

Question: Can our general surgeons charge for reading x-rays and MRIs taken at an outside facility?

Vermont Subscriber

Answer: Probably not.

Only one physician will be paid for reading an x-ray. Consequently, if a surgeon reads the x-ray that a facility radiologist has already read, and for which he has generated a report, the surgeon won't get paid.

If a radiologist is available, he or she most likely will read the results and bill for the service.

If the surgeon reads the exam results, however, he or she must write a separate radiological report that should not be a part of the visit report. In such as case, the surgeon may bill the appropriate radiological code with modifier 26 (Professional component) attached.

If a patient comes to the surgeon's office with an x-ray or MRI report in hand, the surgeon cannot charge simply for examining the films to determine the nature of the problem. He or she is not necessarily interpreting the results. Rather, the physician uses the results to help in the patient's care and treatment. You should consider this to be a part of the medical decision-making component of any E/M service that the surgeon provides on that date.

-- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program.