Primary Care Coding Alert

Question: We used to do X-rays in our practice, but we now send out for them. If the facility that performs the service sends us the disk, can our providers charge for the reading?

Codify Subscriber

Answer: When a radiologist takes an X-ray and does not interpret it, the radiologist would bill for the technical component of the service using modifier TC (Technical component). If the radiologist only interprets the X-ray, he or she would then use modifier 26 (Professional component) to denote provision of the interpretation and report. If the radiologist provides both components, he or she reports the appropriate CPT^® code without a modifier, indicating he or she provided the “global” service.

Typically, you would not use modifier 26 to bill for your provider’s reading, since he or she is likely not interpreting the X-ray and providing an accompanying report of the interpretation. Reviewing an X-ray in this situation would typically be regarded as part of the patient’s evaluation and management (E/M) visit. Under these circumstances, the reading would inform the management of the patient’s condition and contribute to the complexity of medical decision making, which helps assign the appropriate E/M level for the encounter.