Pulmonology Coding Alert

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

Illinois Subscriber

Answer: The radiological codes (70010-79999) in the CPT manual include both the professional and technical components of the procedure. The technical component includes labor and supplies. The professional component includes the physician's work of interpreting the results and issuing a report. Billing a code such as 71010 (Radiologic examination, chest; single view, frontal) means that the physician performed the interpretation and owns the equipment.

Modifiers that are used with these x-ray codes specify the components with which the billing physician was involved. Modifier -26 (Professional component) is appended to the radiologic code when the physician performs only the professional component, such as interpretation. Modifier -TC (Technical component) is used by Medicare and is appended to the x-ray code to show that the physician owns the equipment and wants to recover the reimbursement for the technical component. Since your physician does not own the equipment, you can only report the professional component (71010-26), because this involves the interpretation of the films.

It is important to prepare a separate written report that fully documents the reasons for the examination and the extent of the services provided. Medicare requires this documentation to qualify for reimbursement and ensure that the codes meet the criteria for services provided.

A pulmonologist should not bill for interpretation (71010-26) when that service is also performed by a radiologist. For example, you see a child presenting with a cough and respiratory distress. The physician sends the child to radiology for a chest x-ray. If the radiologist performs the x-ray and also interprets the x-ray before sending the results to you, the radiologist will bill for the professional component.

However, there are instances when you can bill for the professional component. For example, the same child is sent to radiology for a chest x-ray, and the mother brings the film directly to your office. You interpret the x-rays and diagnose 480.2 (Pneumonia due to parainfluenza virus). The appropriate code would be 71010-26 reported along with the relevant diagnosis code.