Orthopedic Coding Alert

Question: Can we bill for reviewing x-rays? If a patient comes in with x-rays and the report is already in there and the orthopedist agrees with the report, it is my understanding we cannot bill for reviewing x-rays. If a patient comes in with the x-rays and the report and the orthopedist determines that the report is incorrect, may we bill for professional component using a -26 modifier (professional component)? A patient comes in with x-rays from another physician or facility but there is no report with the x-rays. The orthopedist now has to review and interpret can we bill for the professional component using a -26 modifier?

Madeline
Milburn, N.J.

Answer: If you provide a written interpretation that would be of the equivalent detail of the one provided by the radiologist, you can bill the interpretation in the scenarios listed. There must be more documentation than knee x-ray normal or knee x-ray shows arthritic changes in the E/M documentation.