Oncology & Hematology Coding Alert

Question: Should we append modifier -26 to 76140 when we perform a consultation on x-rays?

Wisconsin Subscriber

Answer: Because 76140 (Consultation on x-ray examination made elsewhere, written report) is designated for the physician only, you do not need to append modifier -26 (Professional component) to it.
 
You should only report 76140 if a physician from another institution requests your physician's opinion on a radiograph and you send that physician your interpretation. You should not report 76140 if a physician within your practice or hospital asks you to reread an x-ray that was primarily interpreted by another physician within the same practice. Instead, report 76140 when you interpret an imaging study that was primarily obtained and interpreted by a physician from a different practice and with a different provider number.
 
Medicare and some private payers assign "0" relative value units to 76140 and will not reimburse you for this service. If your commercial insurer allows payment for this service, ask for the coverage guidelines in writing before billing 76140 to avoid unnecessary denials. Your practice should establish a policy related to billing the patient for reinterpretations of outside films. If you intend to bill for this service, you should obtain an advance beneficiary notice for patients whose payers do not provide payment for 76140.