Pediatric Coding Alert

Answer: Although pediatricians may look at and evaluate x-rays, the action alone is not necessarily billable. To report the interpretation, the pediatrician must be the only physician officially to read and issue a written report of the x-ray. Aradiologist, instead of the pediatrician, normally interprets the x-ray, which includes writing a report, and bills for it with the appropriate radiology code (70010-79999) appended with modifier -TC (Technical component).

A pediatrician sometimes provides the x-ray in his office and interprets it. In this case, you should assign the appropriate radiology code (70010-79999) without a modifier. Because x-ray codes often require a modifier, you should understand why one would not apply in this case.

Radiology codes consist of two parts: a technical (modifier -TC) and professional component (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 reports the professional component by appending modifier -26 (Professional component) to the same code. When the physician who owns the equipment also interprets the film, the doctor assigns the radiology code without modifier -TC or -26. The unmodified code contains both components.

Suppose your pediatrician orders a frontal and lateral chest x-ray, which he performs and interprets. Because the physician in this case provides both code components, no modifier is necessary. Therefore, you should report the unmodified film code (71020, Radiologic examination, chest, two views, frontal and lateral).