Pediatric Coding Alert

Sometimes a pediatrician, not a radiologist, interprets x-rays performed on a patient. To bill properly the interpretation for an x-ray performed by another physician, the pediatrician must use modifier -26 (professional component) correctly.
 
Radiology codes (70010-79999) consist of two components technical (modifier -TC) and professional (modifier -26). The party who owns the equipment bills for the technical component by appending modifier -TC to the radiology code, and the party who interprets the film bills for the professional component by appending modifier -26 to the same code. When the physician who owns the equipment also interprets the film a common situation in many pediatric primary care groups the physician bills the radiology code without modifier -TC or -26. The unmodified code includes both components.
 
A separate written report, clearly set apart from any notes about the encounter itself, is essential when billing for x-rays. Whether coding for both technical and professional components or with modifier -26, dictate a separate report for the interpretation, says Richard Haynes, MD, FAAP, a member of the American Academy of Pediatrics (AAP) coding and reimbursement committee and a pediatric orthopedist at Shriners Hospital for Children in Houston. "The x-ray report must be separate from the notes for the encounter," he stresses. You should use "I" language: For example, don't say, "The x-ray shows a fracture of the right ulna"; say, "I examined the x-ray, which shows a fracture of the right ulna." When written in this matter, your report will clearly show that you read the x-ray and are not simply repeating the radiologist's report.
Pediatrician Is Interpreter Only
If the scan is performed by a technician elsewhere and the pediatrician interprets it, the pediatrician should bill with the appropriate radiology code, with modifier -26 appended, says Diller Groff, MD, FAAP, chief of pediatric surgery at Kosair Children's Hospital in Louisville, Ky., and a member of the AMA CPT editorial panel.
 
If the pediatrician owns the x-ray equipment, takes the x-ray, and interprets it, he or she should bill the x-ray code with no modifier, Groff says.
 
X-ray taken elsewhere: For example, a child comes into your office with a fever, cough and respiratory distress on a Saturday morning. You send the child for a chest x-ray and ask the mother to bring the film back because you know the radiologist won't be in to interpret it. The technician performs the x-ray, and you interpret it as pneumonia. Bill 71020 (radiologic examination, chest, two views, frontal and lateral) with modifier -26 appended. You will also bill an E/M visit (99214-99215) for that day. Use diagnosis codes 480.x (viral pneumonia), 482.9 (other bacterial pneumonia; bacterial pneumonia unspecified) or 486 (pneumonia, organism unspecified). A separate radiology report [...]