Orthopedic Coding Alert

Question: One of our physicians bills for the interpretation of x-rays brought in with the patient at the time of his or her visit. He states that certain E/M codes allow him to do this and others do not. These x-rays may have come from the primary care physician and thus do not have a radiologists reading. Some are special studies and/or hospital films which do have a radiologists report. He is billing the x-ray code with a -26 modifier. What is the correct way to code?

Anonymous OH Subscriber

Answer: The reading of x-rays is included in the E/M code under decision making. When it is a review of someone elses report, whether they are a radiologist or a primary care physician, this would be included in the overall decision of the level of E/M service, and would not be billed separately. The only time that it would be acceptable to charge separately for a second reading of an x-ray would be when there is a reason to suspect that the original findings were incorrect. In that case, if your physician provides a separate, signed written reportdistinct from his or her E/M documentationit would be appropriate to bill the x-ray code with a -26 modifier (professional component). This would be an exceptional situation; billing in this manner for all x-rays brought into the office could be construed as fraudulent billing in the case of an audit.