Component, Location Shed Light on X-Ray Coding
Published on Fri Feb 01, 2002
Orthopedists make routine use of x-rays as part of good healthcare practice, sending patients to outside facilities for x-rays to be taken, taking them in-house, examining x-ray film that patients provide or ordering x-rays at the emergency department (ED). X-ray procedures present certain challenges to the orthopedic coder, who must take a variety of circumstances into account when billing for them.
Technical and Professional Components
Codes for x-rays and other radiological services describe both the technical and professional components of the procedures.
The technical component includes labor and supplies (such as the built-in costs for equipment and film), as well as the fee for the technician who takes the x-rays. When a facility is responsible for the technical portion of a service only, that service or test (e.g., 72010, Radiologic examination, spine, entire, survey study, anteroposterior and lateral) is billed with modifier -TC (Technical component).
Note: Although modifier -TC is a CMS modifier and is required for Medicare claims, it may not be accepted for non-Medicare claims.
The professional component includes the physician's work and overhead expenses covering interpretation of diagnostic tests, diagnostic and therapeutic radiology and pathology services. When the physician merely interprets the x-ray, append modifier -26 (Professional component) to the x-ray code.
Outside Facility
If a patient presents to an orthopedist with neck pain, the physician is likely to order an x-ray of the affected area and code 72040 (Radiologic examination, spine, cervical; two or three views), 72050 ( minimum of four views) or 72052 ( complete, including oblique and flexion and/or extension studies).
An orthopedist may send a patient to an outside facility where a radiologist takes x-rays, interprets them and sends his or her assessment and the film(s) to the orthopedist. "Orthopedists may feel entitled to bill for a second radiological interpretation when the first was done by a radiologist, because they always review the films themselves and may or may not agree with the radiology report," says Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University
Orthopedic Associates in New Brunswick, N.J.
Coders often misunderstand modifier -26 and try to append it to the x-ray code in these cases. Although the orthopedist will no doubt look at the films when following up with the patient, chances are this service is included in the E/M visit (99211-99215, Office or other outpatient visit ...).
"If the physician provides the first reading of these films and prepares a signed radiology report," adds Stout, "only then can he or she bill for the professional component." Otherwise, reviewing x-rays is considered part of the E/M service when the physician is viewing films taken before the visit. Since an official radiological report already exists, there is no additional professional [...]
