Pulmonology Coding Alert

Question: The pulmonologist orders chest x-rays for a patient who goes to an outside laboratory, which takes a complete, five-view chest x-ray. Upon receiving the x-rays from the lab, the pulmonologist performs the interpretation and report. Can I report x-ray codes for this service, even though our pulmonologist did not take the x-rays?

Tennessee Subscriber

Answer: You can code for the professional portion of the x-ray -- if the pulmonologist has a contractual arrangement with the outside facility allowing him to perform these duties. If the pulmonologist has such a contract, append modifier 26 (Professional component) to 71030 (Radiologic examination, chest, complete, minimum of four views) on your claim. When using modifier 26, the pulmonologist must be the only physician interpreting the x-rays.

If the facility already has a radiologist on staff to provide the formal report of interpretation, the pulmonologist may not provide and bill for an "over-read." In other words, he cannot just add his comments to the radiologist's interpretation and charge for the service.

-- Answers to You Be the Coder and Reader Questions were answered/ reviewed by Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta; and Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.