Outpatient Facility Coding Alert

Question: I bill for both our urgent care center and the Emergency Department. An urgent care physician completed X-rays for a worker’s comp patient and the ER physician interpreted the result and listed his findings in the progress note. When I send the paper claim to workers’ comp, do I need to include some type of “report” from the urgent care center’s X-ray service, or does the finding in the progress note stand as sufficient documentation of the X-ray so the center will receive payment?

Vermont Subscriber

Answer:  A finding reported in the progress note is not sufficient for billing the professional component of the X-ray service. You’ll need complete documentation of the physician’s order and who completed the patient’s X-ray before billing from the urgent care center.

Before filing for the ER physician, verify that he completed the official interpretation instead of passing the film along to a radiologist. If the ER physician did interpret the film, include modifier 26 (Professional component) on his claim.