Otolaryngology Coding Alert

Question: My otolaryngologist orders x-rays for two sinus views and interprets them. How should I report the services?

Maryland Subscriber

Answer: Whether you should bill for the x-rays and the otolaryngologists interpretation depends on where the x-rays are taken. If staff perform the x-rays in the office, you should report 70210 (Radiologic examination, sinuses, paranasal, less than three views) without a modifier to indicate that the otolaryngologist completes both the professional (modifier -26) and the technical (modifier -TC) component. Using the global x-ray code (70210) tells the insurer that the office owns the x-ray equipment and the supplies, and the physician interprets the film and writes a report of his findings. If the otolaryngologist bills for the x-rays, make sure he writes a full x-ray report in the chart, not just states film clear.

On the other hand, if a facility performs the x-ray, you will probably not report a radiology code. Because the hospital bills for the technical side, you should not bill the global x-ray code or the technical component. In addition, in a facility setting, a board-certified radiologist usually interprets the film and issues a written report of his findings. Because only one physician may bill for the professional component and the radiologist will file for this, the insurance company will reject a second interpretation.

Some otolaryngologists want to personally review the films and charge for interpreting the x-ray. If a radiologist performs that portion, you should not also bill for it. You may consider the interpretation when determining an E/M code. For instance, if your ENT documents that the interpretation involves increased medical decision-making, the service may contribute to a higher-level E/M code (such as, 99201-99215, Office or other outpatient visit for the evaluation and management of a new or an established patient )