Pulmonology Coding Alert

Question: A primary care provider (PCP) saw a patient complaining of difficulty breathing and took X-rays. Based on the results of those, he diagnosed the patient with chronic bronchitis and referred the patient to our practice. The patient brought the films to our practice without the radiologist’s written report. So can our pulmonologist bill for his own interpretation of the film?

Connecticut Subscriber

Answer: No. The pulmonologist should not bill for an interpretation of the results if a radiologist provided a formal report and interpretation, regardless of the pulmonologist’s receipt of the report. The radiologist performs and bills for an interpretation and then forwards the interpretative report to the PCP or referring physician. Medicare and private carriers will pay only once for separately billed diagnostic services.

It is standard practice for radiologists to write reports for every patient, but when a patient presents to a pulmonologist with only the X-ray films in hand, the patient probably forgot to bring the report or the patient’s PCP failed to forward the report to the pulmonologist.

If your pulmonologist wants compensation for attending to a patient who presents with films, they should document in the progress notes any extra work that could allow you to code for a higher E/M level. For instance, a woman with a cough and shortness of breath presents to your pulmonologist, but she brings only the X-ray film not the radiologist’s written report. The pulmonologist interprets the films and develops a treatment plan.

In this case, the pulmonologist will count two points for the independent visualization of the films. If the physician still needs to review the formal report, and attempt to obtain this report at the conclusion of the visit, the pulmonologist can be credited with another point. “Data” satisfies one of the two medical decision making categories required for reporting moderate-complexity decision making, a key component for 99204 (Office or other outpatient visit ...).