Otolaryngology Coding Alert

Question: The otolaryngologist I work for reads CT scans and MRIs and wants to bill codes such as 70450 (Computerized axial tomography, head or brain; without contrast material), 70552 (Magnetic resonance [e.g., proton] imaging, brain [including brain stem]; with contrast material[s]) and 70210 (Radiologic examination, sinuses, paranasal, less than three views) appended with modifier -26 (Professional component). For example, when the patient brings in the films to the visit, we receive a report from wherever the films were taken, and the otolaryngologist reads the films. Often, she says the report is inaccurate. Should we bill for these services?

Illinois Subscriber

Answer: Carriers will only pay for one interpretation of the film. The radiology department that sent the report has already been paid, so the otolaryngologist should not bill these services. The only exception is when the physician is working in the emergency department (ED) and interprets the film on the spot, but otolaryngologists are unlikely to be in the ED interpreting film, other than for a patient with a fractured nose. Even when this is the case, the decision about whether to bill can be difficult because the radiology department, which will later be sent the film, will also want to bill for it.

It should also be noted that when the otolaryngologist reports reading the film, a written report is required even if no payment occurs. This can pose a potential liability problem if, for example, the otolaryngologist's report addresses the sinuses only and does not interpret other parts of the film.