General Surgery Coding Alert

Question: A patient presented for follow-up four months after surgery. The physician provided an E/M service (99212) and a complete radiologic exam (72052). Can I report both services and, if so, must I attach modifier -25 to 99212?

Missouri Subscriber

Answer: Unless another physician specifically asks the surgeon for his or her opinion, the "re-read" of an x-ray previously interpreted by another physician such as a hospital radiologist counts only toward the "Amount and Complexity of Data" section of Medical decision-making. You may not report the service separately, because this would constitute "double-billing."
 
If you provide the x-ray in the office and a radiologist or other physician does not read the films, and the surgeon interprets the results and dictates a separate report, you may report 72052 (Radiologic examination, spine, cervical; complete, including oblique and flexion and/or extension studies) or other exams separately.
 
You need not use modifier -25 (Significant, separately  identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to receive reimbursement for an E/M service and radiology procedure on the same day.