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Answer: Medicare policy indicates that family physicians (FPs) can interpret x-rays, if it falls within their scope of practice. Many FPs own x-ray equipment within their suite and routinely read the films.
Most coding experts say that Medicare s reference to scope of practice is included to ensure that an appropriately trained physician is reading a specific x-ray. For instance, it is not correct for a podiatrist to read a chest x-ray, or for a urologist to interpret an x-ray of a broken tibia. In most cases, an FP has been trained to read straightforward x-rays (i.e., skeletal films), and so may perform, code and bill them.
Generally speaking, a family physician will refer a patient to a radiologist for more complex conditions that demand greater expertise.
When reporting x-rays, coders can bill the CPT radiology code one of three ways: the code without a modifier if the FP took the x-rays and read them; the code with the -TC modifier (technical component) if the FP simply took the films, but had them read by a radiologist; and the code with modifier -26 (professional component) if the films were taken elsewhere (e.g., at the hospital) but read by the FP. For example, a practice might report 73600 (radiologic examination, ankle; two views) if they performed the global service, but would report 73600-TC for only taking the films and 73600-26 for only reading the films. |
