Pediatric Coding Alert

Question: A 6-year-old patient reported with left wrist pain from playing croquet. The pediatrician sent the child to the radiology office for an x-ray, but there was no radiologist on staff, only technicians. A  technician took two views of the wrist, then gave the film to the father, who took it back to the pediatrician for interpretation. Can the pediatrician report the x-ray, and if so, how?

North Carolina Subscriber

Answer: The pediatrician can code for the interpretation of the x-ray, but not for taking it. Use CPT 73100 (Radiologic examination, wrist; two views) with modifier -26 (Professional component) appended.

Anytime an off-site technician takes an x-ray and returns it to the pediatrician for interpretation, the pediatrician should report the appropriate radiology code with modifier -26 to indicate that he did not actually take the x-rays. The office whose staff performed the x-ray would report the appropriate radiology code with modifier -TC (Technical component).

The reimbursement race begins when the visit ends. When a payer gets claims using modifiers -TC and -26, the insurance company only pays the first claim it receives.

-- Information for Reader Question and You Be the Expert provided by Richard H. Tuck, MD, FAAP, medical director of Quality Care Partners in Zanesville, Ohio.