Pulmonology Coding Alert

Question: How should I bill for x-ray interpretation when we do not own the equipment?

Illinois Subscriber

Answer: In certain cases, your pulmonologist can append modifier -26 (Professional component) to radiological services (71010-71555) for an interpretation of x-ray film if he or she doesn't own the x-ray equipment. But if you bill for the interpretation, you cannot count the interpretation in your complexity of medical decision-making, coding experts say. Follow these recommendations for when you can legitimately bill modifier -26.

The radiologist "invites" the pulmonologist to provide a second diagnosis. For example, a PCP sends a patient with chest pain (786.5x) and coughing up blood (786.3) to a radiologist. But after the radiologist takes the x-rays, he cannot determine a diagnosis, so he refers the patient to a pulmonologist to inspect the film results.

A radiologist is unlikely to request a second diagnosis, however, because a second diagnosis requires that the pulmonologist have a greater level of expertise than the radiologist. Pulmonologists typically do not possess the greater level of expertise.

The radiologist didn't complete a diagnostic report. If a radiologist saw the patient but didn't write a diagnostic report, the pulmonologist can bill for his review of the film results, coding experts say. Poor communication or misunderstandings could lead to conflicts with the radiologist, however. So make sure the radiologist didn't write a report and the PCP forgot to forward your pulmonologist a copy.

Also, if a report is missing, your physician might want to confer with the radiologist to avoid any conflict between the services, experts say.

In any case, a pulmonologist who bills the professional component for an x-ray interpretation takes a high risk of facing fines, fraud charges or a lawsuit, coding experts say.

- Answers for You Be the Coder and Reader Questions were reviewed by Carol Pohlig, BSN, RN, CPC, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia; and Anthony M. Marinelli, MD, FCCP, chairman of the American Thoracic Society's Clinical Practice Committee.